Dental Disease

Perhaps one of the most common causes of stasis is dental disease. For this reason it is critical that you allow your veterinarian to perform a thorough physical examination, including a detailed dental exam, on your rabbit at least once a year. As your rabbit ages or if he has had dental disease in the past it is possible that your vet will advise that your rabbit’s teeth be examined more frequently. Additionally, any rabbit experiencing GI stasis should have a dental exam as part of the work up. There are many different types of dental disease, from the growth of relatively minor molar points (or spurs), through severe dental abscesses and potentially compromised jaw bones. It is important to note that certain types of dental disease can only be detected with radiographs (X-rays) and/or a sedated oral examination.

Gastrointestinal Disease

Many types of gastrointestinal disease can contribute to anorexia and stasis in rabbits. When this occurs the stasis is known as primary GI stasis. One of the most common causes of primary GI stasis is a poor quality diet. Rabbits have a large fiber requirement, and the bulk of their diet should consist of high quality grass hay. In younger, and in some geriatric rabbits, alfalfa hay is recommended as it is higher in protein and calories as well as calcium. GI stasis is likely to occur in rabbits fed only pellets, or worse yet those fed diets high in sugar and starch, as occurs with rabbits fed oats and/or cereal. Other types of GI disease can cause stasis and these diseases will likely require blood tests, radiographs and various fecal tests to accurately diagnose.

Kidney and Bladder Disease

Kidney and/or bladder disease are perhaps the third most common cause of GI stasis in rabbits. It is believed that the pain and possible toxin buildup in the case of kidney disease lead to anorexia and secondary stasis. Diagnosis may be straightforward in the case of bladder stones, which can be readily palpated at times. However, generally speaking a diagnosis of stasis secondary to kidney or bladder disease will require a detailed physical exam, complete blood work, radiographs and a urinalysis. Depending on the underlying case many of these rabbits will recover their appetite and have resolution of their urinary system disease with appropriate veterinary care.

Reproductive Disease

The vast majority of rabbit owners know the importance of having female rabbits spayed. It has been reported that up to 80% of unspayed female rabbits will develop uterine disease in their lifetime. Sadly, most of these cases will involve the development of potentially fatal uterine cancer or aneurysms.  Usually the first symptom noticed by owners is seeing blood in the urine or on the rabbit’s back end. However, an equally common initial symptom is GI stasis secondary to the uterine pathology. A tentative diagnosis may be achieved based on the pet’s history and symptoms; however a detailed physical exam, radiographs and potentially exploratory surgery (which may be curative if the rabbit is spayed) may be required.

Toxicoses and Lead Paint

It is uncommon for well-cared for rabbits to gain access to toxins. However, after practicing in New York City for several years I have seen many cases of GI stasis secondary to low-grade, chronic lead intoxication. These pets invariably live, or have lived, in buildings built before 1978. That was the year in which the sale of lead paint was banned in the United States. Many rabbits with lead poisoning are “free-range” rabbits. They spend their day out of an enclosure and have the run of the house. Owners may or may not be aware of their rabbits chewing at baseboards, door frames or walls. When lead poisoning is suspected, many owners will state that their home is lead free, even if it was built before 1978. These owners often erroneously believe that renovations and fresh paint means that the lead-based paint has all been removed. This is almost never the case; more often than not the renovations simply cover deeper layers of lead-based paint.

Lead toxicosis appears differently in rabbits than in cats and dogs, and it is unlikely that a non-rabbit savvy vet will suspect this condition. In dogs and cats symptoms are often pronounced, and many times include overt neurological disease. It appears that rabbits are more sensitive to low levels of lead in the blood, perhaps because of their complicated gastrointestinal system. In my experience, lead-poisoned rabbits often demonstrate GI stasis, weight loss and anorexia of several days to weeks’ duration. The symptoms may wax and wane, but no other cause of GI stasis can be found. Lead levels are often in the high normal to low toxic range for dogs. With appropriate treatment the vast majority of these patients make a full recovery.

Conclusion

GI stasis can vary from relatively simple condition for your rabbit vet to diagnose and treat, through one of any number of more complicated and serious medical conditions. You should always seek help from an experienced rabbit vet as soon as your rabbit has showed decreased appetite, or anorexia of 12-hours or more. Owners may not always notice their rabbit’s appetite, and as such decreased fecal production may be the first clue to GI stasis. Once this is noticed a veterinarian should be contacted immediately.

Dogs with Short Faces

The Respiratory System and Brachycephalic Airway Obstruction Syndrome

Brachycephalic breeds make a lot of snorting respiratory sounds, as a matter of course, simply because of the way their throats and faces are shaped. These sounds are generated from a combination of several anatomic deformities that will be described below. These deformities occur to varying degrees of severity. Most brachycephalic dogs are not hampered by their anatomy on a day-to-day basis, but they do have limitations that must be recognized. Severely affected individuals require surgical intervention.

Stenotic Nares

This is a fancy name for narrowed nostrils. The brachycephalic dog’s respiratory passage begins with very small, often slit-like, nasal openings for breathing. This leads to a great deal of open-mouth breathing and panting as the nasal breathing route is limited by its small opening. In selecting a puppy for adoption, it is a good idea to look at the nostril sizes on each member of the litter and look for the widest opening. Stenotic nares can be surgically corrected after the age of five months.

Enlarged Tongue (Macroglossa)

The brachycephalic dog’s tongue can be particularly thick and large, which contributes to the overall obstruction. The French and English bulldogs seem particularly predisposed to this issue.

Elongated Soft Palate

Tracheal Stenosis/Hypoplastic Trachea

The trachea is also known as the windpipe. The brachycephalic dog’s windpipe may be dangerously narrowed in places. This condition creates tremendous anesthetic risk and should be ruled out by chest radiographs prior to any surgical procedures, as anesthetic safety depends on the placement of a tube in the windpipe to secure air passage. If the trachea is too small, intubation may not be possible, and it is important to know this in advance of any planned procedure. The English bulldog is particularly predisposed to this anatomical defect.

Everted Laryngeal Saccules

The normal larynx has two small pockets called ventricles or saccules. When a dog has increased effort to breathe, over time, these little pockets will actually turn inside out inside the throat. When this occurs, it obstructs the throat. This condition can be corrected surgically; however, in many cases, it resolves on its own after the stenotic nares are corrected, so surgery is generally only performed in severe situations. The pug is especially predisposed to this situation.

Heat Stress, Excitement, and Exercise 

Because of all these upper respiratory obstructions, the brachycephalic dog pants inefficiently. A dog with a more conventional face and throat is able to pass air quickly over the tongue through panting. Saliva evaporates from the tongue as air is passed across and the blood circulating through the tongue is efficiently cooled and circulated back to the rest of the body.

In brachycephalic dogs, so much extra work is required to move the same amount of air that the airways become inflamed and swollen. This inflammation leads to a more severe obstruction, distress, and further overheating, which is potentially a life-threatening problem. It should always be a consideration during stressful situations, especially air travel. 

The American Veterinary Medical Association has travel guidelines for brachycephalic dogs.  

The American College of Veterinary Surgeons has further information on brachycephalic obstructive airway syndrome.

Brachycephalic dogs are the most likely candidates for heat stroke.

Altogether, the upper airways of the brachycephalic dog compromise the ability to take in air. Under normal conditions the compromise is not great enough to cause a problem; however, an owner should take care not to let the dog become grossly overweight or get too hot in the summer. Be aware of what degree of snorting and sputtering is usual for your pet, and should your dog require general anesthesia or sedation, your vet may want to take extra precautions or take radiographs beforehand to assess the severity of the syndrome. Anesthetic risk is higher than usual in these breeds, though under most circumstances the necessary extra precautions are readily managed by most animal hospitals.

This reflux generates pain and inflammation. Compounding this problem is the retention of food in the stomach for prolonged periods. The pooling of food in the stomach creates a sensation of nausea and increases the potential for vomiting and/or stomach acid reflux. The English bulldog seems particularly predisposed to GI complications in this way. This sounds like a separate issue from the respiratory syndrome, but in fact, the reflux, regurgitation, and even herniation of part of the stomach into the chest cavity stems from the extreme inhalation efforts made against the upper airway obstruction that comes from the shape of the brachycephalic head. Medications are helpful for intestinal issues as is weight control, but often correcting the respiratory obstruction corrects the intestinal problems as well.

Eye Problems

With most of the nasal bones compacted, brachycephalic dogs tend to have trouble with the way their eyes seat in their heads. The eye sockets are shallow making the eyeballs especially prominent and vulnerable. Often a nasal fold of skin rubs on the eyeball and/or there are eyelashes rubbing on the eye.

Lagophthalmos

Sometimes, the eyes are so prominent that the lids cannot close all the way over them. This will lead to irritation and drying of the center of the eye unless surgical correction is performed. If you cannot tell by watching your pet blink, watch as your pet sleeps to be sure the eyelids close all the way. If the eyelids cannot protect the eyes, blinding pigmentary changes will form where the eyes become irritated.

Nasal Fold Irritation

Many brachycephalic dogs have a fold of skin between the nose and eyes. This skin fold may need regular cleaning as it tends to collect skin oil and moisture but it can also be prominent enough to rub on the actual eyeball. Chronic irritation will show as a pigmented area on the eye surface, especially on the side nearest the nose. This is hard to see without a bright light but if it is noted, a search for the cause is warranted. Depending on the location of the pigmentation, surgery may be recommended.

Entropion (Turned-In Eyelids)

The shortened face leads to rolling of the eyelids in such a way that the eyelashes or even haired skin can rub the eye. This is not only uncomfortable but will damage the eye. Some dogs have eyelids that droop or turn out in one area but turn inward in another area (usually the corner of the eye). Surgical correction may be needed to protect the eye and restore comfort.

Dry Eye (Keratoconjunctivitis Sicca)

Brachycephalic breeds tend to get more than their share of tear production problems. In this situation, inadequate tears are produced so a thick, goopy, yellow eye discharge results. In response to the irritation, the eye becomes pigmented and can become blind if treatment is not instituted. This condition is treatable with medication so it is important to recognize it before it progresses to a point where vision is lost and the goal is simply restoring comfort. 

Risk of Proptosis

Recognize the prominence of the eyes on brachycephalic. The bony eye sockets are very shallow. This means that any blow to the back of the head, even a fairly minor one, can cause an eye to pop from its socket (proptosis) and require surgical replacement or even removing the eye. This can happen also with too much pulling against the leash if the pet is wearing a collar. You may wish to consider a harness for your pet. Traumatic proptosis is frequently blinding to the eye that was popped out.

Other Concerns

The normal dog has 42 teeth in the mouth. The brachycephalic dog also has 42 teeth but a lot less space to fit them in. This means that the teeth will be crowded and growing in at odd angles which, in turn, traps food debris and leads to periodontal disease at a far younger age than in non-brachycephalics. The earlier you begin using home care dental products, the longer you will be able to postpone full dentistry under general anesthesia.

As mentioned, skin fold infections are common amid the facial folds of the brachycephalic breeds. Be sure to examine these areas periodically for redness. Even if the fold does not rub on the eyeball, it will likely need regular cleaning and topical disinfection.

The broad-headed nature of these breeds makes reproduction a tricky matter as a Caesarean section is frequently needed. Difficult labor is common and, as surgical assistance is often necessary, it is important not to breed females with tracheal stenosis (see above). Brachycephalic breeding is not for the inexperienced. 

Altogether, the brachycephalic breeds show plenty of personality and intelligence, just as all dogs do, but because of their specific needs, their owners need extra knowledge. If you have any questions about your brachycephalic dog, don’t hesitate to call your veterinarian.

Bacterial diarrheas are generally a nuisance for the adult animal but can be lethal to a small puppy, kitten, or even a human baby. Most of these problems stem from contaminated food or fecal contaminated environment. Feeding raw food diets to pets dramatically increases the exposure to infectious organisms to the humans in the family. Since these conditions are also human diseases, it is helpful to have some understanding of what they are, even if there are no young pets or immune-suppressed individuals (human or otherwise) at home.

Campylobacter

Plus, because they are small, fluid loss from diarrhea hits them much harder. Furthermore, puppies and kittens are more likely to be housed in groups where fecal cross-contamination is common so they may be more likely to become infected than adult animals. Adult animals commonly have Campylobacter organisms living in their intestines, but they do not experience any sickness due to it.

In humans, Campylobacter infection is a leading cause of gastrointestinal (GI) disease; infected dogs and cats can carry the organism and spread it even if they do not have symptoms themselves.  For this reason, pets used for therapy in assisted living communities and similar situations should be screened for Campylobacter by fecal culture before exposure to people with suppressed immunity. Humans are also infected by consumption of contaminated food, water, or raw milk; only 6% of human Campylobacter infections are attributed to dog exposure.  That said, exposure to a dog with diarrhea triples a person’s risk for developing enteritis from Campylobacter jejuni or Campylobacter coli. Studies screening pet animals for inapparent Campylobacter infections have found surprisingly high incidences of inapparent infection. In one study in the Midwest, 24% of 152 healthy cats were positive, for example.

After consuming Campylobacter organisms, they travel to the lower small intestine, attach, and multiply. They produce a toxin that destroys the lining of the intestine with the result being a bloody, mucous diarrhea (though occasionally a more watery diarrhea is described).  Sometimes a fever results, appetite becomes poor, and vomiting can occur.  Incubation is 2 to 5 days.  The organism can survive as long as a month in environmental feces.

Diagnosis is made by seeing the sea gull-shaped organisms under the microscope; however, there are so many bacterial organisms on a fecal sample that finding the culprit can be tricky. For this reason, a culture is often performed as a more accurate test. Because the organism is microaerophilic, specific culture requirements must be met; the facilities of a reference laboratory are needed.

Treatment is with appropriate antibiotics, such as erythromycin, chloramphenicol or tylosin.

Salmonella

The same is true with puppies and kittens; adult animals are almost never affected by Salmonella infection.

An important exception to the “Salmonella is rare in adult dogs” rule is the case of dogs fed a raw food diet. It has become popular to feed raw foods to pets with the idea that a raw food diet more closely approximates the natural diet that the feline or canine body evolved to consume, and thus, such a diet should be healthier than commercially prepared foods. In fact, cooking food is central to removing parasites, bacteria, and bacterial toxins from food. A recent study evaluating raw food diets found that 80% of food samples contained Salmonella bacteria and that 30% of the dogs in the study were shedding Salmonella bacteria in their stool. Adult dogs are often asymptomatic, but any infected animal or person will shed the organism for at least six weeks, thus acting as a source of exposure to other animals or people. Salmonella organisms are difficult to remove from the environment and easily survive three months in soil. Again, dogs used for therapy around the elderly or children should be cultured for Salmonella.

There are two syndromes associated with Salmonella: diarrhea and sepsis. Salmonella bacteria, once consumed, attach to the intestine and secrete toxins. The toxins produce diarrhea that can be severe and even life-threatening in the young. If this were not bad enough, some Salmonella can produce an even more serious “part two” (sepsis) should these bacteria invade the body through the damaged intestine, causing a more widespread and much more serious infection.

In young animals, the syndrome resulting is similar to that of canine parvovirus thus similar treatment is expected.

E. Coli

Enterotoxigenic E. coli is a common cause of diarrhea in young animals as well as human infants and is responsible for the famous traveler’s diarrhea. These bacteria produce what is called an enterotoxin in the upper small intestine. This toxin, similar to the toxin of cholera, causes the intestine cells to secrete the body’s fluid into the intestine, creating spectacular watery diarrhea and what can be life-threatening dehydration for smaller living creatures.  Young pigs, cattle, and other livestock are commonly lost to this kind of dehydration. Again, the younger and smaller the patient is, the more serious this infection is.

Enteropathogenic E. coli also produce diarrhea in humans and animals. Rather than a secretory diarrhea as above, they simply destroy the intestinal cells where they attach. Diarrhea still results, but it creates more damage to the intestinal lining.

Enterohemorrhagic E. coli is similar to enteropathogenic E. coli but with more associated inflammation. This type does not seem to be a problem for small animals though they can carry it asymptomatically.

It would seem that antibiotics would be the obvious treatment for a bacterial disease, yet for E. coli it is surprisingly controversial. It seems that the use of antibiotics can enhance the synthesis of toxins by these bacteria; plus, oftentimes, antibiotic use only serves to make E. coli more resistant in the GI tract. Antibiotics are generally reserved for those animals (or people) who seem the most sick or who have evidence of bacterial invasion in the bloodstream. Basically, treatment is supportive care until the patient’s immune system regains the upper hand.

In Conclusion

Bacterial diarrheas are an especially serious consideration in the very young and in the weak or compromised, be they human or non-human. It is not unusual for apparently healthy animals to carry these organisms and shed them into the environment and feeding raw foods greatly increases the risk of this kind of latent infection. If you are considering raw food diets, especially if someone in the home is very young or has a compromised immunity, discuss prevention of these infections with your veterinarian.