T. Bradley Bays
A 3-year-old female dwarf rabbit presented to me with a grossly distended abdomen and the owners said that it hadn’t eaten or defecated in more than a week. The patient had seen by 2 other veterinarians during that time and they each gave the rabbit an enema, based on the presumptive diagnosis of constipation, without benefit of radiographs or other diagnostic tests. The rabbit was dyspnic and kept its body in an upright standing position on the hay bin in order to breathe because the distended abdomen was pushing on the diaphragm. Radiographs evidenced a fluid filled mass in the caudal abdomen pushing the other viscera cranially. A severe hydrometra of both uterine horns was discovered on exploratory surgery, but the patient died during the OVH. This case made me realize that if practitioners didn’t know what normal behavior was in rabbits that they wouldn’t recognize abnormal behavior and it began my quest to disseminate information about exotic animal behavior, medicine, and surgery.
This is the advice that I would give to all practitioners in order to make them more successful in treating their small mammal patients.
Look at the whole patient:
- Watch how the patient acts before the exam and re-covers after the exam—this can be more important than the exam itself as signs can be very subtle (esp. in prey species).
- Full physical exam, looking at the affected part last.
- Often the patient will appear normal, but the owner has noticed changes in behavior that indicate a problem, listen to the owner.
- Obtain a full history including diet and environment and recent changes that may have been made in these things.
- Don’t overlook issues not in presenting complaint.
A case is described where a ferret presented with swelling on its face. A tooth root abscess was discovered in the upper right canine tooth. By performing a full physical exam to assess the whole patient and by performing appropriate diagnostic bloodwork it was discovered that the patient also had insulinoma which without diagnostics might have been missed.
A second case is described where a sugar glider had been being treated with antibiotics for over 2 years for a non-responsive periodontal infection of the lower incisors. A full exam uncovered an infection in the perianal sacs and after this was discovered the owner disclosed that the patient often suckled on the peri anal area as a result of the discomfort. When the anal sac infection was resolved a hemi-mandibulectomy was performed to remove the lower incisors and the patient now lives more comfortably.
- Insist on annual exams for NTs.
- Recommend 2–4 exams/year since most of your small mammals have fast metabolisms, shorter lives and are great at hiding illness until it is advanced.
- This gives you greater familiarity with the patient.
- It gives you the opportunity to catch problems earlier.
- It gives you more opportunity to reiterate recommendations on diet, environment and enrichment.
Regular exams give you and the owner the opportunity to work better as a team and gives the patient more opportunity to live a longer, more comfortable life. A case is described about an abdominal mass that was detected in a rabbit that presented for a nail trim. When the owners allowed a workup and surgery it was discovered that the rabbit had a pyriform appendix infection. The affected portion of the GI tract was resected, and the rabbit did well, all because a full exam was performed before the nail trim could be done.
Perform diagnostics to guide your treatment choices and monitor resolution of problems.
- Blood work
- Culture and sensitivity
- Fine needle aspirates
Often practitioners call for advice on cases and just provide the signalment and clinical signs noted. As with any species, diagnostic tests are needed to determine diagnosis, prognosis and to develop and effective treatment protocol that will address the whole patient.
Look at the whole patient.
- Watch for clues outside the scope of your exam and the history taken
- Pictures and videos that the owner has taken
- Size and consistency of stool
A case is described where the size and shape of the stool led to a diagnosis of a urethral plug. The importance of taking radiographs that include the entire distal urethra of small mammals is discussed.
Don’t Overlook the Less Obvious Problems by Focusing on the Obvious
A case is described of a rabbit with a large abdominal mass that turned out to be a torsion of the uterus secondary to hydrometra. Upon further inspection of the radiographs and during the exploratory a torsion of the stomach was also discovered. The stomach was derotated and then a gastropexy was performed.
Don’t Be Afraid to Try!
If the owner knows the risks but wants you to try:
- Don’t be afraid to try.
- Don’t hesitate to refer to someone who has more experience and will try.
Two examples are given of advanced cases where the prognosis is guarded to poor, but the outcome was good with surgery. These include a guinea pig with a huge abdominal mass that turned out to be a uterine leiomyoma corrected with OVH, and a hedgehog with necrotic prolapsed tissue that turned out to contain reproductive tract and was also corrected with OVH.