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Letters
B. Schuhmann and I. Cope write: We both welcome and would like to thank Frances Harcourt-Brown for her letter and comments. We do feel we have addressed most of her comments in the paper. Our paper presents the analysis of 145 154 | Veterinary Record | August 9, 2014
cases and the potential success of medical therapy. However, we agree it can be a dilemma whether to choose medical or surgical treatment, and we have tried to help aid that decision process, by no means claiming we have a ‘magic bullet’, but rather a protocol that can help medical cases and is very successful in the medical cases we see. We acknowledge there are other protocols and options that can also work, but these were not used in our cases and so were not included. It would be too difficult and long to discuss all aspects of the decision process of case selection in a paper and, as noted, there is a complete chapter about this in the BSAVA book mentioned (Harcourt-Brown 2013). It was not the aim of the paper to give a decision tree, but of course fully assessing the rabbit properly is essential before deciding on the protocol and treatment course. We are sure that with time other protocols could be analysed and compared. In our experience, more medical cases are seen than surgical cases, possibly because truly obstructed rabbits or rabbits with a torsion die within 12 to 24 hours and so do not get the chance to be presented to the clinic. Certainly, if unnecessary high-risk (and high-mortality) surgery can be avoided, we feel this is to the benefit of the patient. We would strongly recommend the use of glucose testing to aid in the decision process, as discussed in our paper, and this should be combined with clinical signs and the results of other tests such as radiographs. However, it must be remembered that blood glucose testing is also not foolproof and might not correlate with clinical signs and the cause as predicted, and again is, therefore, not a guaranteed diagnostic ‘magic bullet’. Continuous monitoring should occur throughout the treatment regime and, if progress and an improvement in clinical signs do not occur, then the course of treatment or surgery should be reassessed. Certainly, as discussed in our paper, radiography is very useful in assessing the progress of the disease or any underlying disease process and, therefore, if surgery for tumours, strictures or torsions is required. We also agree there are many options to the treatment regime and we present one here that has been used successfully in a significant number of cases. Certainly fluid therapy could be given via subcutaneous or intravenous routes, and the route obtainable will depend on the severity of disease, the demeanour and attitude of the patient (eg, will it keep a line in and not twist itself up in the line?), the presence of hypovolaemia and the accessibility of any veins. Metamizole is available in mainland Europe and can be obtained by special licence in countries where it is not available. As discussed in the paper, an
alternative is cisapride (available in the UK) and this has also been used successfully in many cases. Other drugs can also be used, such as ranitidine, especially in gastric cases. The exact combination varies with the exact disease and clinical signs seen, to which point we agree with Mrs Harcourt-Brown. However, if hypomotility and dehydration are present, the rabbit will not improve without medical intervention and support even if the pellet is small enough to technically fit through the gastrointestinal tract, or given endless time or luck. An opioid can certainly help (such as buprenorphine), but care must be taken with dose as, at a high enough level, it could induce sedation and gastrointestinal hypomotility, thus being counterproductive. This would also be the main risks with butylscopolamine/ metamizole. We feel that the statement in Mrs Harcourt-Brown’s letter, ‘Conversely, no surgery can result in suffering and death’, is ambiguous and needs clarifying. Clearly, taken literally, this is not true. Anaesthesia can result in death and complications such as peritonitis, post-surgical adhesions, wound break down or intestinal problems due to constriction of the surgery wound can lead to suffering and death. We assume Mrs Harcourt-Brown meant that carrying out no surgery can result in suffering and death if no treatment or inappropriate treatment and assessment occur. We hope this helps to address some of the points and helps the discussion on treatment and assessment of a difficult disease process in rabbits. B. Schuhmann, Tiermedizinzentrum, Kufsteiner Str. 22, Berlin, 10825, Germany e-mail: [email protected] I. Cope, Cambridge Veterinary Group, 89a Cherry Hinton Road, Cambridge CB1 7BS
Reference
HARCOURT-BROWN, F. M. (2013) Gastric dilation and intestinal obstruction. In BSAVA Manual of Rabbit Surgery, Dentistry and Imaging. Eds F. M. Harcourt-Brown, J. Chitty. British Small Animal Veterinary Association. pp 172-189
doi: 10.1136/vr.g5001
Downloaded from http://veterinaryrecord.bmj.com/ on June 24, 2015 - Published by group.bmj.com
Treatment of gastric dilatation in rabbits B. Schuhmann and I. Cope Veterinary Record 2014 175: 154
doi: 10.1136/vr.g5001 Updated information and services can be found at: http://veterinaryrecord.bmj.com/content/175/6/154
These include:
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Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Letters
B. Schuhmann and I. Cope write: We both welcome and would like to thank Frances Harcourt-Brown for her letter and comments. We do feel we have addressed most of her comments in the paper. Our paper presents the analysis of 145 154 | Veterinary Record | August 9, 2014
cases and the potential success of medical therapy. However, we agree it can be a dilemma whether to choose medical or surgical treatment, and we have tried to help aid that decision process, by no means claiming we have a ‘magic bullet’, but rather a protocol that can help medical cases and is very successful in the medical cases we see. We acknowledge there are other protocols and options that can also work, but these were not used in our cases and so were not included. It would be too difficult and long to discuss all aspects of the decision process of case selection in a paper and, as noted, there is a complete chapter about this in the BSAVA book mentioned (Harcourt-Brown 2013). It was not the aim of the paper to give a decision tree, but of course fully assessing the rabbit properly is essential before deciding on the protocol and treatment course. We are sure that with time other protocols could be analysed and compared. In our experience, more medical cases are seen than surgical cases, possibly because truly obstructed rabbits or rabbits with a torsion die within 12 to 24 hours and so do not get the chance to be presented to the clinic. Certainly, if unnecessary high-risk (and high-mortality) surgery can be avoided, we feel this is to the benefit of the patient. We would strongly recommend the use of glucose testing to aid in the decision process, as discussed in our paper, and this should be combined with clinical signs and the results of other tests such as radiographs. However, it must be remembered that blood glucose testing is also not foolproof and might not correlate with clinical signs and the cause as predicted, and again is, therefore, not a guaranteed diagnostic ‘magic bullet’. Continuous monitoring should occur throughout the treatment regime and, if progress and an improvement in clinical signs do not occur, then the course of treatment or surgery should be reassessed. Certainly, as discussed in our paper, radiography is very useful in assessing the progress of the disease or any underlying disease process and, therefore, if surgery for tumours, strictures or torsions is required. We also agree there are many options to the treatment regime and we present one here that has been used successfully in a significant number of cases. Certainly fluid therapy could be given via subcutaneous or intravenous routes, and the route obtainable will depend on the severity of disease, the demeanour and attitude of the patient (eg, will it keep a line in and not twist itself up in the line?), the presence of hypovolaemia and the accessibility of any veins. Metamizole is available in mainland Europe and can be obtained by special licence in countries where it is not available. As discussed in the paper, an
alternative is cisapride (available in the UK) and this has also been used successfully in many cases. Other drugs can also be used, such as ranitidine, especially in gastric cases. The exact combination varies with the exact disease and clinical signs seen, to which point we agree with Mrs Harcourt-Brown. However, if hypomotility and dehydration are present, the rabbit will not improve without medical intervention and support even if the pellet is small enough to technically fit through the gastrointestinal tract, or given endless time or luck. An opioid can certainly help (such as buprenorphine), but care must be taken with dose as, at a high enough level, it could induce sedation and gastrointestinal hypomotility, thus being counterproductive. This would also be the main risks with butylscopolamine/ metamizole. We feel that the statement in Mrs Harcourt-Brown’s letter, ‘Conversely, no surgery can result in suffering and death’, is ambiguous and needs clarifying. Clearly, taken literally, this is not true. Anaesthesia can result in death and complications such as peritonitis, post-surgical adhesions, wound break down or intestinal problems due to constriction of the surgery wound can lead to suffering and death. We assume Mrs Harcourt-Brown meant that carrying out no surgery can result in suffering and death if no treatment or inappropriate treatment and assessment occur. We hope this helps to address some of the points and helps the discussion on treatment and assessment of a difficult disease process in rabbits. B. Schuhmann, Tiermedizinzentrum, Kufsteiner Str. 22, Berlin, 10825, Germany e-mail: [email protected] I. Cope, Cambridge Veterinary Group, 89a Cherry Hinton Road, Cambridge CB1 7BS
Reference
HARCOURT-BROWN, F. M. (2013) Gastric dilation and intestinal obstruction. In BSAVA Manual of Rabbit Surgery, Dentistry and Imaging. Eds F. M. Harcourt-Brown, J. Chitty. British Small Animal Veterinary Association. pp 172-189
doi: 10.1136/vr.g5001
Downloaded from http://veterinaryrecord.bmj.com/ on June 24, 2015 - Published by group.bmj.com
Treatment of gastric dilatation in rabbits B. Schuhmann and I. Cope Veterinary Record 2014 175: 154
doi: 10.1136/vr.g5001 Updated information and services can be found at: http://veterinaryrecord.bmj.com/content/175/6/154
These include:
Email alerting service
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
