Frances Harcourt-Brown's First Owners' Programme


Many thanks to Denise Devoto for proof-reading the first draft of this and adding lots of  things I'd missed

On Saturday 11th April 2015, All Ears were very excited to attend Bunny SuperVet Frances Harcourt-Brown's first training day for owners in Harrogate, UK. Frances is the only RCVS recognised specialist in rabbit medicine and surgery in the UK. She started the day by saying she was going to challenge a lot of our beliefs - and she did, creating some strong debate on the way home. But it was also interesting that there were small points where Nigel (Frances' vet husband) disagreed with Frances, or where Frances disagreed with All Ears Guest and Foraging Expert Dr Twigs Way - as there isn't always one 'right' answer - just compromises to be made or different approaches to risk. So I think as owners, we have a duty to learn as much as we can about our bunnies, and keep asking questions and challenging ideas, and then make our own opinions based on our research, our experience, and our bunnies.

Look out for future events here. As well as the owners' event, Frances is also offering a comprehensive series of continuing professional development courses for Vets and Vet Nurses, so if anyone knows a Vet that would like to improve their knowledge in rabbits, these courses offer a fantastic opportunity for them to learn from Frances' vast experience, and specialist knowledge. 

Frances was amazingly generous with her time and her knowledge, and Sabina asked if we were able to share her notes on the All Ears website. Frances very kindly said we could, so they're included below. However, as has been mentioned on both Facebook and the Rabbits United forum, the slides can be misinterpreted if taken literally, so I've also included some of the context and some of my own thoughts and reflections. Also some of the lectures contained videos, which can't be seen via these pdfs, but definitely helped to embed some of the knowledge and understanding behind her opinions.  

It was also suggested on Facebook that if this information is useful to you, you may wish to consider a donation to Camp Nibble, the Rabbit and Rodent Rescue that Frances Harcourt-Brown is a patron of. Donations can be made here

The day covered five presentations:
1. How the Digestive System Works
2. Ileus, stasis, bloat or blockage - how to tell them apart
3. Dental disease - what happens to the teeth
4. The anorexic rabbit - when to worry
5. What's the best diet - myths and truths

1. How the Digestive System Works

The first part of this was a detailed explanation of how rabbits' teeth grow and their structure before moving on to how the different particles are ingested. The more time a rabbit spends chewing, the stronger its jaw bone and muscles will become. You may see your bunny grinding its teeth to maintain the surfaces on the teeth - this is quite normal and different to the tooth grinding caused by pain.

Frances went on to say that proteins, lipids (fats), sugars and starches are absorbed similarly to other species, but rabbits are also able to use microbes to break down plant material - such as dietary fibre - to gain extra energy. Anything that isn't digested in the first stage passes into the colon, which separates the undigested materials into things which the microbes can convert which are fermented and broken down, and things which the rabbit cannot ever digest e.g. lignin (woody substance that provides rigidity to plants) and fur, which are excreted as hard faecal pellets. The caecum is an integral part of a rabbit and is effectively like a big eco-system that is crucial to maintaining the rabbit's health.

There's a theory that sugars and starches disrupt the caecal microflora and cause diarrhoea in rabbits which Frances believes originates from a Carbohydrate Overload Theory where commercial rabbits can die of enteritis. However, rabbits digest the carbohydrates before they reach the caeceum and so this is unlikely. Also enteritis is an acute, fatal diarrhoea, not just a mild sticky bottom. However, there is a risk of enteritis from antibiotics.

Although  sugary and carbohydrate rich foods are unlikely to imbalance the microbes in the caeceum, they can still cause problems as they make the rabbit fat, so it is physically unable to reach its anus and ingest caecotrophs. Additionally a diet low in fibre will affect the consistency of the faeces as the fibre is what makes the caecotrophs firm.  

2. Ileus, stasis, bloat or blockage - how to tell them apart

'stasis' is a term owners use to describe a rabbit not eating. 'ileus' is the vet equivalent. 'bloat' tends to involve a distended abdomen, and 'blockage' is an intestinal obstruction.

Rabbits are very susceptible to stress, and stress slows down their gut motility. So a huge range of things can stress the rabbit and therefore cause stasis, but there will always be a cause. It may be as mild as a cat walking through the garden or a change in routine or may be much more serious like severe dental pain or illness. In animals like humans, horses etc it's really obvious how much pain they're in - rabbits are far more subtle so it's hard to tell if the anorexia is due to something serious or not.

However, a study Frances undertook in her practice in 2012 evidenced that a rabbit's blood glucose rises in response to stress so if you test this, you can get an indication of how serious the problem is. 

More frequent, but lower doses of pain relief e.g. meloxicam (metacam) are more effective and safer than high doses. in Frances' analogy "Why take 20 paracetamols when 2 will do?". 

Bloat is usually due to a physical obstruction in the intestine. It differs from 'normal' ileum as it will be a more sudden, complete anorexia, and the stomach will be more distended. Pellets of impacted hair are the most common cause- not from grooming, but when the bunny has eaten its normal faeces (as well as the caecotrophs) and one of these hard pellets has caused a blockage. 

It's often mentioned that sprinkling herbs or food pellets in hay to encourage the bunny to forage for their food and eat more hay is a great idea - however Frances said that when she did this, three of her bunnies suffered from intestinal blockages from ingesting faecal pellets. 

Sometimes, ileus or a blockage will pass without interference and the rabbit will be ok. Other times, without medication or surgery, the rabbit will die. All Ears would ALWAYS recommend taking an anorexic rabbit to the vet as soon as possible, and to NEVER syringe feed a rabbit without having seen your vet to rule out the possibility of a blockage.

Please note - in the slides about Frances' rabbit Joe - infacol, massaging his stomach and making him run around were NOT options Frances would consider doing as massage/forcing him to move would cause him more pain in the short term, and re infacol, whilst many vets believe it may help, Frances thinks it's ineffective as it's designed to break down bubbles in frothy bloat in babies to make them burp or vomit. As rabbits can't do either, it doesn't really help.

3. Dental disease - what happens to the teeth

Dental disease can be caused by genetic problems, trauma, or tumours - however over 90% of dental disease was classified by Frances as Progressive Syndrome of Acquired Dental Disease (PSADD).

Fortunately, PSADD is less prevalent than 10 years ago, but basically is due to rabbits getting insufficient calcium from their diet (e.g. from selective feeding from muesli). This weakens their teeth and bones, so the teeth are not properly supported in the skull, so even if the bunny is rescued and moved to a hay based diet at this point, it still really hurts them to eat. So a bunny who doesn't eat hay may well not be because they're fussy/used to a bad diet, but because it hurts to eat the hay. If so, make sure the bunny has as many greens as possible, and if the bunny is on a pelleted diet, make sure it's not too many pellets and a good quality one.

Frances believes that quite often PSADD has already started with bunnies whilst they are still with breeders as tiny babies. Some breeders start feeding babies from 4 weeks old on muesli as it's the cheapest type of food available for them to feed on mass. Dominant siblings are the most at risk, as the will get the pick of the muesli, and via selective feeding will choose the 'tastier' morsels which often lack calcium, resulting in lack of bone density and setting them up for future dental issues.

Please note: Clipping is NOT an option for incisor malocclusion, and unless it's really really extreme circumstances, euthanasia also seems inappropriate.  

Frances personally prefers to use molar clippers and a rasp to reshape the molars to remove spurs. Whilst she considers burring an option for vets who are comfortable with power tools, she doesn't advocate burring teeth down to the gum line as then the rabbit will need to wait for the teeth to grow back before they can start eating properly again, and the teeth will lose their shape, preventing the bunny from maintaining them in the natural way.

4. The anorexic rabbit - when to worry

So this presentation was about the vast array of different causes of anorexia (or 'stasis') in bunnies, and how critical they were. I found the slides on this handout really hard to follow as the writing on the slide with the bullet pointed list was so small and without colour, it was hard to tell which items were highlighted each time the slide was brought up. But one really good way is to test your rabbit's glucose levels as an indication as to the level of emergency. The other thing I would highly recommend is getting your rabbit to the vet as soon as possible if it's not eating. If it's just mild stress preventing them from eating, a bit of pain relief and gut stimulant will speed their recovery, and if it is a life threatening emergency, then the vet should be more likely to notice and will know how to fix it.

Frances suggested that some of the often quoted home remedies are either a bit unfair (either forcing a bunny to move if it's in pain or massaging its stomach) or futile (simethicone) - but said that whilst pineapple juice won't dissolve furballs, it will hydrate the rabbit. 

The immobility response (putting a rabbit on its back) was also discussed in this lecture. There is currently a huge campaign from the RWAF (& others) to raise awareness of this as studies have shown that it can be incredibly stressful to a rabbit, potentially dangerous and is largely unnecessary.

However, Frances believes that the definition of 'tonic immobility' is different from an immobility response. Depending on the manner in which it is done (a gentle, experienced manner vs 'scruffing' or grabbing the rabbit) will affect the stress level of the rabbit, and it is a technique that Frances uses, for example when taking an ultrasound or x-ray without sedation, or to clip a rabbit's fur when it is unable to clean itself and at risk of flystrike. She showed us a video of her eliciting an immobility response in a rabbit in order to take an x-ray. This was done in a very gentle manner, gently weighting the bunny down with a small 'sand bag' so it could not move and it did not seem unduly stressed. She also said that the blood glucose level of rabbits treated in this way were not overly high, and showed us that rabbits on their back will still eat. 

Denise said "I've actually seen Frances do this with Beth when she had to examine her abdomen before operating and Beth is a 6kg boofer of a bunny! Whilst it's not something I would advocate, it clearly has its place for experienced vets - particularly if a bunny could not cope with a GA or sedation or has a potentially life threatening condition"

My personal view is that it is not something that should be done for fun or as a general way of handling a rabbit. However, sedating a rabbit to take an x-ray/ultrasound also has risks, and preventing flystrike in a limited mobility bunny is also very important for the bunny's health. So, I can accept it has a role where both owner and vet agree there is a medical benefit in using this technique in a certain situation on a particular bunny. However, I also believe that there is a lot of animal cruelty and neglect, and so there is also a place for a campaign to raise awareness that it is not an acceptable procedure in 'normal' circumstances. I guess not dissimilar to the idea that everybunny should have a bonded bunny friend - which also has exceptions based on bunny personalities/health issues/the rabbit's history. 


5. What's the best diet - myths and truths

Frances advocates a mainly grass and forage diet for a rabbit, keeping it as close to the diet of a wild rabbit as possible. Obviously, wild rabbits do not eat hay, but survive on a diet of grass and fresh forage, and a domestic rabbit would thrive on this diet. However, this would require approximately 500g of grass per rabbit per day, which might not be practical for pet rabbits living in urban areas where their owners have limited access to parks and bridleways, so hay is a convenient and healthy alternative.

Where owners are looking to try new plants and forage but are unsure what to go for, Frances highly recommended Dr Twigs Ways book Foraging for Rabbits available here.  Frances said that rabbits are resistant to toxins in plants, or don't eat the plants, so as long as the rabbit has a variety to choose from, Frances doesn't think owners have to worry much about making sure plants are safe for the bunny. However, Twigs said there is always somebunny who will want to just try a little bit of something highly toxic, so owners may wish to err on the side of caution. 

Frances also thinks that too many veggies causing diarrhoea is a myth too, and that it is more likely that the introduction of new veg stops the rabbit from eating its caecotrophs temporarily and the owner sees the caecotrophs and thinks it's diarrhoea so stops feeding veg and feeds more concentrated food - this then makes the rabbit fat which also stops it eating its caecotrophs. Rabbits should have more veg/greens/hay and less (or no) concentrated food. 

Lettuce was also mentioned, as this is often deemed unsafe on rabbit food lists and Frances disagreed with this. There is more on lettuce here.

Pre-biotics and probiotics were mentioned. It has been shown that they may increase the rate at which commercial rabbits can be grown, there is no evidence to support any medical benefit to rabbits or if they can help rebalance gut flora in poorly rabbits.

Calcium was also discussed - as this is a factor in urinary tract diseases in rabbits. Low calcium diets tend to recommend avoiding high calcium veggies - however, as veggies are mostly water, they still contain a low % of calcium.

Concentrated food (pellets/nuggets) are only 5-10% water, hay 15% water, whereas grass and veggies are 80-95% water. So, if calcium needs to be reduced, a much much greater impact can be had on the rabbit's diet by restricting or eliminating pellets from the rabbit's diet and increasing the proportion of fresh greens, than from eliminating 'high calcium veggies' - which are mostly water. 

Increasing water intake is also important as this dilutes the urine, and therefore the concentration of minerals in the urine, resulting in less sediment. Rabbits drink more from bowls than bottles. There is also more water in grass (or other forage/veggies) than hay.

Twigs also suggested bottled water/water filters for rabbits with calcium problems in areas with high  calcium in tap water (e.g. East Anglia).


I hope this has been interesting/useful. Please feel free to leave any feedback below or get in touch via email/facebook, and please keep an eye on Frances Harcourt-Brown's website (here) for future events, as they are very interesting and informative (and the cake is amazing!)

(donations to Camp Nibble can be made here. You can also support them via easyfundraising or Pets at Home VIP club by selecting 'Meanwood" as your home store)