Medical Care |

Medical Care




Bunny 20

Georgia House Rabbit Society

• Observing Your Bunny• The Rabbit Digestive System• Gastrointestinal Slowdowns, Bloat• The Bunny Home Health Exam• Administering Medication (Oral, Injections)• Administering Fluids• When You Need More Than Home Care• Recognizing Medical Emergencies• Your Bunny Home Health Toolkit

Your Bunny's Best Health Tool is YOU!
YOUR power of observation is bunny's key to long, healthy life!
• Be Sherlock Holmes. Observe your bunny's:
– Eating times and quantities, liquid consumption– Posture, spots for laying down, sleeping– Respiration rate and sound (if any)– Fecal pellet size and quantity; urine color / quantity– Gut feel, etc.
• Check every day for one month, for you to learn what "normal" is • Keep a journal (reinforces observation, record for history / patterns) "Holmes, you see everything." To which Sherlock Holmes replied "I see no more than you, but I have trained myself to notice what I see."

The Rabbit Digestive System
• Bloat (distended stomach / gas), stasis (gut mobility shutdown) are some of the most common ailments you will treat • Most gut problems are from bacterial imbalance vs. blockage• Rabbits require delicate balance of fiber, hydration, electrolytes• Gut is easily upset by excess sugars, stress, lack of hydration, electrolyte imbalance, quick changes in diet • Rabbits have no vomit reflex• Refusal of food more than 24 hours is medical emergency. Rabbits can die 12-24 hours from first symptoms • Bloat can occur from true obstruction or "functional blockage" from gut • Past misnomer of "hair balls". Most are undigested food material• There is no best diet for all rabbits. Observe all your bunny's reactions to X-Ray of the Rabbit Gut

Rabbit with Bloat / Gas

Second X-Ray of Rabbit with Bloat / Gas
Distended stomach filled with gas

Common Causes Stasis / Ileus
• Stress or psychological triggers (loss of bonded companion, separation from owner, move to new territory) • Dehydration• Pain from underlying condition (gas, joint disease, fractures, etc.)• Molar issues (overgrowth, abscess)• Urinary tract disorders (infection, bladder sludge)• Soft tissue problems (tumors or abscesses)• Parasites (coccidiosis)• Intestinal blockage (undigested food, foreign matter e.g. carpet)• Insufficient fiber in diet• Overgrowth of harmful bacteria from too rich a diet, diet high in sugars Note your rabbit may eat relatively normal amounts of food, almost up to the time the GI Recovery may take up to 2 weeks, and have fits/starts. Provide consistent gentle nursing, and try to determine cause. Ileus is a symptom, a clue of some underlying problem

Observing for Shock
• Observe respiration, lethargy• Gums may be white or bright pink if in shock. Loud teeth grinding• Take temperature – Over 104 F or under 100 F is serious medical emergency (101-103 normal) • If temperature low, warm bunny using heating pad (only while holding), hot water bottles, towels heated in dryer, microwave safe corn husk or buckwheat pillows • If temperature high, cool bunny with cold water bottles, air conditioning, fan, wetting ears, frozen water bottles • Sub-Q fluids may help stabilize (warm fluids if bunny's temp is low)• Take to emergency vet if unable to stabilize temperature, or other symptoms such as seizures, difficult respiration are occurring • Use flexible child thermometer (NO GLASS)
• Lubricate with Vaseline (or some equivalent)
• Be gentle. Never force, as rectal walls are easily damaged
• Withdraw gently and slowly when done
• Normal is 101 – 103F. Treat immediately if outside normal range
• Can take 2 hours of warming to return to normal temp
• Rabbit likely to get active after returning temp to normal range, and then may
have another temp drop 2-3 hrs later. Recheck • Monitoring temp. following surgery is also critical (along with pain mgmt.)• If lower than 97F have bunny hop around a little while and recheck. Thermometer may be against a fecal pellet, and not the tissue wall Location to Insert Thermometer Practice the Tao of Poo
• Observe your rabbit's fecal pellet size and quantity • Cecal pellets normally eaten (vitamins)• Overproduction of cecal pellets may indicate too rich a diet or underlying medical issue • Watch for decreased size or quantity of fecal pellets. Increase fiber and hydration if either occurs. Consider Normal Fecal Pellets
additional G.I. treatment options • Size varies by your rabbit. Determine your bunny's • Watery or unformed pellets indicates diarrhea and are an immediate medical emergency • Mucus in stool may also indicate medical emergency. Normal Cecal Pellets
Mucus may occur after a period of stasis Diarrhea / Loose Stools
• True diarrhea (unformed, watery fecals) – May signify overgrowth of toxins or underlying disease– Take to vet or emergency vet immediately. Do not wait! • Loose stools – Occasionally cecal pellets may be soft (should not be runny)– Treat loose stools with ½ - 1 tsp of rolled oats in food (Plain – Eliminate all treats and sugars– Consider probiotics or Oxbow critical care to re-establish gut flora. Antibiotics alone may cause loose stools from disruption of bacterial flora balance – Cholestyramine (Questran) can be given to bind with toxins (Use especially if diarrhea or mucus is present) – Encourage increased consumption fiber / hay, adequate – If repeat illness occurs or no signs of improvement in 24-48 hrs, have rabbit examined by vet. Parasites, underlying illness, dental issues, etc. may be to blame Pictures courtesy Esther van Praag, The Bunny Home Health Exam
• Examine eyes (for non-clear or excessive discharge, redness of eyelids, cloudiness of retina) • Examine ears (sores, mites, discharge, obvious external wax build up) • Examine nose (discharge, sneezing) and front paws (for yellow staining) • Examine front teeth (malocclusion / lack of symmetry, drooling, wet chin, bad breath) and color of gums (should be soft pink) • Examine skin / fur (mites, sores, mats, abscesses, excessive flaking)• Examine bottoms of feet (sores, loss of hair – sore hocks) and nails (for clipping)• Examine "bunny privates" (discharge, caked fecal matter, urine scald) The Bunny Home Health Exam Cont.
• Feel length of body, lumps of skin, down legs (Look for lumps, scars, wounds, hair loss, etc.) • Gently feel the gut. Listen with stethoscope (if available)• Listen to breathing• Take temperature if concerned about illness (Normal 101-103 F)• Smell if any odor present (Note strong or pungent scent by anus / scent glands is normal) – Keep a medical journal of all medications, illness, observations, vet visits and – Take bunny to vet if anything unusual observed in your home exam, in order to receive proper diagnosis and treatment. Rabbit illnesses can progress

– Take your bunny to vet for a "wellness exam" once a year. If you can afford it, consider having laboratory workup during period of "health" to use as comparison if bunny becomes ill Treating Most Common G.I. Issues
Hydration, hydration, hydration!
– Oral fluids or sub-Q fluids (LRS, Saline, or NaCl if bunny has not eaten in – If bunny's temp. is low, warm fluids first in bowl of warm tap water • OxBow Critical Care – Contains enzymes to break up masses, calories, liquids you add (water) and probiotics (100 -120 ml / 5 lb / day broken into 4+ feedings) • Banamine or Metacam for pain – From your vet. Usually once per day– Banamine is injectable and can also reduce toxins from intestinal bacteria, and is preferred following major surgery (1-2 days dose) – Metacam is a NSAID, usually given orally and easiest for home or long • Simethicone (Pediatric GasX) for gas – 1-2 ml once an hour for 2-3 doses, then 1 ml every 8 hours – Safe to give even as a precaution • Rabbit safe probiotic, to re-establish gut flora – Culturelle, Propbios Treating Most Common G.I. Issues, Cont.
• Reglan (Metoclopramide) or Propulsid (Cisapride) for gut mobility – Work on different areas of digestive track and can be used simultaneously– Caution to not use with full obstructions or problem with pyloric valve. Vet to – Decreasing effectiveness of Reglan with significant repeated use– Can not use narcotic painkillers with Reglan due to potential dangerous interaction • Fresh hay….fresh hay….fresh hay…….(did we say fresh hay?)!!!
– Offer a variety and unlimited quantity of hay (with exception of alfalfa, which is too high in protein and calcium and more likely to cause bloat) – Crude fiber is key to gut motility, the gut must have it to function
• Fresh, wet, leafy herbs can also be offered – Mint, basil, dill, cilantro, tarragon, parsley are all good choices • B Vitamins from veterinarian - Stimulates appetite• Salt lick or unsweetened Pedialyte for electrolytes• Lactulose - laxative, or olive oil – May coat masses making them harder to rehydrate. Use when gut starts moving again • Water and plenty of exercise• Reduce or eliminate treats, sugars! Giving Oral Medications
• Cover / hold head• Insert at angle behind the front teeth (to avoid liquid going in lungs) • Go slowly, let bunny swallow• Keep Children's liquid Benadryl on hand for allergic reactions to medications (swelling, seizures, breathing problems) Other options (more risky):• Kneel and place bunny between legs on the floor or cradle bunny on back • Make "bunny burrito" (wrap carefully in towel)• Can give pills by cutting tip from 3 ml syringe; Insert bit of banana, pill and then more banana or peanut butter (pill not easily spit out.) Safer to crush pill to prevent choking • Pick the rabbit up, hold along the length of arm, with the other hand on top to steady, holding the scruff because this IS an emergency • Swing downward with the arm that's holding the rabbit, to get 'gravity' and motion to help dislodge • Can also stroke the throat upward toward the mouth (Clear the nasal passage and mouth by wiping away mucous) • Once the rabbit is calmer you can syringe out mucous or other foreign matter with a bulb syringe (If you don't have one, clear as much mucous out as you can, with a damp cloth or paper towel) • If the rabbit is small and you can hold between your hands, cup bunny in your hands and swing downward in a long arc Giving Subcutaneous Injections
(Under the Skin)
• If possible use a fresh needle if you had to draw medication from a vial (which can dull needle)• Pull up a "tent" of loose skin, most common on scruff of neck between shoulders• Insert needle into "tent" (90 degree angle), about half the length of the needle • If you can, without withdrawing the needle, pull back slightly on plunger to ensure no blood appears in needle (i.e. aspirate needle to ensure you are not in a vein)• If no blood appears, push plunger in to deliver medication• After withdrawing needle rub skin lightly between fingers (lessens scaring and leakage of medication) • For repeat injections, envision a clock / circle on neck and alternate site (12, 3, 6, 9 pm) to vary injection site each time• Can also wet skin with water to more clearly see injection site Class Practice Time
• Use bunny "model" (rubber glove stretched over bowl) to practice tenting skin and inserting needle • Walk through each step in instructions• Each person in class has option to practice at least one • Next: Demonstration on live bunnies in our shelter, needing medications or treatments Giving Intramuscular Injections
(Into the Muscle)
• Secure bunny under your arm (more likely to struggle with intramuscular injection, as they are slightly more painful) • Find muscle injection site by feeling with hands. Wet area, if needed, to help see• Tense /pinch the area lightly with fingers• Insert needle slowly and firmly, about one half needle length • Pull plunger back slightly to look for blood• No blood means it is safe to inject. If blood appears, withdraw needle and insert again• Remove needle and discard Giving Subcutaneous Fluids
• Warm IV bag in bowl of warm water (to temp 90-100 F) especially if bunny is in shock and has low temp. Keep end with port out of water • Don't use alcohol swab (only causes pain), but ensure area is clean• Create similar "tent" (as with subQ injections)• Insert needle at least half the length into the skin. No blood should appear in tubing. Release "tent" and ensure needle isnot poking out other side • Hold bunny still (hand on head and rear works well)• Administer fluids (50-100 ml per 2.2 lbs/day most common, but may vary based on hydration level) • A build up of fluids as a bulge under the skin is normal Giving Subcutaneous Fluids Cont.
• When done, roll skin slightly between fingers after removing needle• Fluids will settle to lower part of body over next 30 – 60 min., and then be absorbed in next 24 hrs • May need to treat multiple days in a row, or every other day• SubQ fluids not recommended for bunnies with heart conditions or breathing • Ask your vet for an un-punctured bag of LRS (lactated ringer's solution) solution (or normal saline if your bunny has kidney failure, or NaCl if bunny has not eaten in more than 36 hours) to keep at home. Needles range in size 14-20. "Green" 18 works well • Refrigerate bag once punctured, and use within 1-2 months. Discard if cloudy• Use a fresh needle each time (limits pain and infection risk)• Fluid administration into a vein should only be attempted by your vet When to Consult Your Vet
(within 24 hours)
• Not eating in 24 hours, audible sounds from gut without stethoscope• Mucus or parasites in stool• Tilted head, loss of balance, jerking eye movements • Repeated head / ear scratching or head shaking• Partial paralysis or immobility, lethargy• Repeated sneezing, nasal discharge or eye discharge• Straining to urinate or urine that appears very white or gritty (excessive calcium buildup / sludge) • Loud teeth grinding, hunching in pain• Loss of interest in treats, favorite foods or favorite activities• Sores on bottom of feet (sore hocks) • Consider alternative medicine (e.g. acupuncture) as additional support after consulting your veterinarian Do not wait for regular veterinarian appt. if any of these are present: – Shallow or labored breathing, or very rapid breathing (if nothing – Weak heartbeat– Paralysis– Unresponsiveness or unconsciousness– Seizures or convulsions– Open wounds, bleeding – Inability to regulate temperature after 2-3 hours of home treatment (below 100 or above 104 F) – Grey or bright pink gums– Diarrhea– Severely distended stomach (bloat) Make mental note of temperature before going to vet to report reading before stress The Bunny Home Health Toolkit
Hand sanitizer (for the human) Name and contact information of Baby wipes or tissues your veterinarian, and nearest Toe nail clippers, scissors , tweezers emergency vet center Styptic powder to stop bleeding Your contact information Iodine solution or antibiotic wash to clean wounds Flexible digital thermometer and Vaseline For more advanced kits: Bandage material, gauze pads IV fluids (un-punctured bag) and Bottle of water (drinking water or wound care) Soft blanket or towel Stethoscope (preferably a good Heating pad or hot water bottle infant stethoscope, or the best you Simethicone (GasX for Infants) Metacam (for pain) from your veterinarian Oxbow Critical Care and feeding syringe Non-expired plain Pedialite, plain canned pumpkin (if not using Critical Care) Children's Benadryl (oral liquid) Visit HRS at at any time for more health and care information Other Good Reference Sources
House Rabbit Handbook By Marinell Harriman. Approx. $11 • When Your Rabbit Needs Special Care. Traditional and Alternative Healing By Lucile C. Moore and Kathy Smith. Approx. $15 • Rabbit Health in the 21st Century, Second Edition. A Guide for Bunny By Kathy Smith. Approx. $18 • Textbook of Rabbit Medicine By Harcourt-Brown. Approx. $143 House Rabbit Society Educator


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I Shall Gather Them Back From the Countries and Bring Them Back to Their Own Land (Ezk:34.18) Emma Pierce Abstract: Mental illness is not ordinarily considered to be the domain of Theology. Here I propose to ask the question: Should it be? This is a question for practical theology. What would theology make of the experience of mental illness if it heard it first-hand, through the voice of the witness rather than second-hand, through the filter of the analyst's interpretation? My point here is very simple: understanding as distinct from knowledge about any human experience can only be truly gained by listening to the voice of the witness speak their experience as experience. In this paper I invite theological reflection on only one aspect of mental illness, but it is one of the several aspects universal to every mental illness. Depression! The question for theological reflection is this: Is this an illness as posited by the Human Sciences, or is it an ordinary part of the human condition so misunderstood that it is fostered and nurtured into mental illness by secular ears that do not recognise the existential dimension that underpins depression?1

Know Your FSA /HSA Eligible and Ineligible Expenses Maximize the Value of Your Reimbursement Account Your Flexible Spending Account (FSA) and Health Savings Account (HSA) dol ars can be used for a variety of out-of-pocket health care expenses. Take a look at the fol owing lists for a better understanding of what is and is not eligible. Eligible Expenses