Veterinary Vertex

Exploring the Benefits of a Lidocaine CRI in Rabbit GI Obstruction Management

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Are you ready to have your minds blown with some intriguing insights on the use of a lidocaine CRI in rabbits? Dr. Gail Huckins is here to share breakthrough findings, which suggest that this treatment option not only bolsters survival rates for rabbits with gastrointestinal obstruction but also has the potential to lessen owner costs and nursing burdens. You'll be hooked as Gail takes us on a journey through her research process and the fascinating discoveries she's made along the way.

We'll delve into the implications of Gail's findings and exploring the benefits of a lidocaine CRI. If you're wondering where you can get your hands on Gail’s paper, we've got you covered. It's published in JAVMA or you can also check it out online. Plus, don’t forget to drop your ratings and reviews on Apple Podcasts or your favorite podcast platform. Prepare to be enlightened on this life-saving treatment for rabbits!

Read the full article: https://doi.org/10.2460/javma.23.05.0274

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Sarah Wright:

You are listening to Veterinary Vertex, a podcast of the AVMA Journals. In this episode, we chat about how a lidocaine CRI improves survival and rabbits with gastrointestinal obstruction, with our guest Gail Huckins.

Lisa Fortier:

Welcome to Veterinary Vertex. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today, we have Gail joining us. Gail, it's really great to see you again, and thank you so much for being here today.

Gail Huckins:

Yeah, thank you so much for having me. I'm excited to talk about my paper.

Sarah Wright:

Excellent, let's dive right in. Rabbit GI problems can be extremely frustrating for both zoological companion animal veterinarians and their clients. Your manuscript and JAVMA may give vets and their clients some hope when it comes to treating this issue. Can you give our listeners a bit of background on this study?

Gail Huckins:

Yeah. So when I started my residency at the University of Wisconsin in 2019, one of my resident mates actually had used this technique of using lidocaine CRIs for rabbit obstructions at a previous facility. We hadn't used it at UW before, so we decided to give it a shot and, honestly, found really, really great improvement in our clinical outcomes for those patients. But just trying to find anything in the literature, there really wasn't anything available. So that's one of the big problems with exotics medicine in general is that people might be doing things, but if it's not in the literature, then other people don't know about it and don't know how efficacious it might be. So that's what really kind of prompted me to decide to go ahead and do some actual statistics and looking at what our results actually have been.

Sarah Wright:

We can always use more evidence-based literature in zoological space, that's for sure. Yeah, most definitely so. What were some of the important findings from the study?

Gail Huckins:

Yeah, so really some of the important findings. The biggest one is that using lidocaine CRI significantly improves survival to discharge in rabbits that have a diagnosed gastrointestinal obstruction. In our study, about 90% of the rabbits that were treated with a lidocaine CRI survived to discharge, compared to about 55% of rabbits that were not treated, and the statistics showed that rabbits treated with a lidocaine CRI were about seven to eight times more likely to survive to discharge, which is obviously a pretty huge finding. That's the big one. The other one was that a lot of previous treatments for gastrointestinal obstruction involve things like orogastric decompression or multiple medications, and one of the important things I think shows about this paper is that you can get really great survival to discharging your rabbits with obstructions without having to do really invasive things like orogastric decompression, and really all you need to do is give them IV fluids and a lidocaine CRI and things resolved pretty quickly, which was pretty fantastic. That really cuts down on owner costs and also on nursing burdens and that sort of thing, which is really great.

Lisa Fortier:

Oh, that's amazing, Gail. Congratulations on a really impactful manuscript for veterinarians and our patients. You talked a little bit about how the thought process came upon to write this manuscript but for those people that are in their residency, can you give a little more background of what sparked your research interest in rabbit GI obstruction?

Gail Huckins:

Yeah, so I mean part of it's a little personal. I've had pet rabbits since vet school and actually lost a pet rabbit to a GI obstruction my last year of vet school. So it's definitely improving outcomes for that sort of condition is personal for me, but also from just a clinician standpoint it's a fairly common presentation that we get. I think a lot of owners and even a lot of ER vets, general practitioners have this impression that GI obstructions always have a poor outcome, like there's really nothing you can do about it, especially since rabbits are unique in that our first approach isn't surgical for GI obstructions, which is a bit odd compared to large animals and domestic dogs and cats. So I was really interested in getting more information out there. As far as treatment options, just to show that it's not an automatic death sentence in rabbits and just because you don't do surgery in them doesn't mean that there aren't treatment options available.

Lisa Fortier:

That's really inspiring. Speaking of inspiration, it's one thing to think you identified a clinical problem and thought, well, how can we do this better? You did the study, but then how do you find the inspiration to complete the manuscript, to get it written, to get it done and published? It's a long road.

Gail Huckins:

Yeah, yeah, it's a long road too, especially because I started it towards the end of my residency, so it was kind of competing with finding a job, studying for boards, taking boards. So it's just the main thing that the reason that I found the resilience to do it is again because it was really important to me just seeing how many patients that we had come in very critically ill and hypovolemic shock. Owners were worried that they weren't going to make it and we were able to put them on IV fluids and a lidocaine CRI. This wasn't included in the paper just because we didn't have the data recorded, but anecdotally, from my perspective of the cases that I worked on, a lot of these obstructions cleared up within 12 to 24 hours, which is pretty amazing. So just wanting to get that information out there, because a lot of exotic vets even boarded, exotic vets that I've talked to haven't really considered using this treatment option for GI obstructions and rabbits.

Lisa Fortier:

Serendipitously, you observed something, but you didn't a prior plan for it, so looking forward to the next JAVMA manuscript from you that says these obstructions clear up in 24 to 36 hours.

Gail Huckins:

That would be great. Yeah, I just need to get the data, which is the problem, like trying to get people to record when animals are started on something to when their clinical signs resolve, and a busy ICU can be a little bit tricky.

Lisa Fortier:

And you talked about some of the most important findings from your manuscript. But what things really surprised you?

Gail Huckins:

I think the thing that surprised me the most.

Gail Huckins:

Well, there were two things. One is there's been quite a few studies in rabbits that show the lower temperature body temperature that they present at the poorer their prognosis is, which is usually kind of used as a correlation to how severe their shock is. And we actually found in our study that temperature didn't have an effect on survival, which was pretty interesting compared to, like I mentioned, those other studies. The other one was that there's been again some papers out there that show that hyperglycemia is usually pretty indicative that an animal has a GI obstruction, compared to GI stasis, which is now called rabbit gastrointestinal syndrome. We actually found that 30% of our rabbits that were treated with lidocaine had a pretty normal blood glucose and were only identified on imaging. So again, I think that's a pretty big finding. That's not a majority but that's a fairly significant portion of our population where we didn't kind of get that information from the blood glucose. So I think it's important for vets out there to know just because an animal isn't hyperglycemic doesn't 100% rule out that it has a GI obstruction.

Sarah Wright:

Yeah, those are some very important points and I actually am very familiar with the articles that you're talking about. I remember them from journal clubs, so always good to get more data and to present the most updated

Gail Huckins:

Yeah, exactly the temperature thing was really surprising to me because that has been really consistent across rabbit medicine that if they present with really low temperatures the prognosis is a lot poorer.

Sarah Wright:

So more evidence for our clinicians to have at their disposal. So I know you were chatting about how you did your residency at UW with my good friend Chelsea. She was a rotating intern when I was a fourth year student in Illinois and just saw her at zoo vets actually in Nashville not too long ago.

Gail Huckins:

Yeah, she's awesome.

Sarah Wright:

Yeah, how did your advanced training prepare you to write these manuscripts?

Gail Huckins:

Yeah. So I think just advanced training in general really helps you learn how to put together research projects and write manuscripts. Zoo medicine especially. For a lot of specialties you only have to write one research project and then submit one paper. For zoo medicine you have to have three published first author papers in order to sit for boards, so the requirements for publishing are pretty high. So even in my specialty internship at Kansas State University I wrote between case reports and what's your diagnosis. I wrote five papers that year and then for residency I've written about two or three that have gotten published so far and I still have a couple of projects that I'm still working on. So for zoo medicine, just because there's not a lot of literature out there, it's really important for house officers to publish, so we get a lot of support from clinicians as far as putting together research projects and case series for publication.

Lisa Fortier:

Gail, I honestly didn't know it took that many manuscripts. First author manuscript, that's a lot.

Gail Huckins:

Yeah, it used to be five and then they decreased it to three. Which is insane. That's a high bar, yeah.

Lisa Fortier:

So if you authors out there that are listening, I would highly suggest that when you write in your cover letter to the editor to put that in there that this is required for boards and at least at JAVMA we try to expedite those papers. You know a lot of us have been there and we understand that. You know it's tough as you were saying, Gail once you move on. It's really tough to close the loop on these manuscripts when other things are taking you away. So just remember to put that in your cover letter.

Gail Huckins:

Yeah, I mean especially for zoo medicine, because a lot of the residencies tend to be very clinically busy, so you may only have like one office day a week in some of them to actually sit down and write. Otherwise you're doing it on your own time. So you know it's a lot to balance.

Sarah Wright:

Well, kudos to you, though, for being able to accomplish that and, you know, write the two to three manuscripts, like you said, and if you have more coming, we would love to see them at JAVMA or AJVR, so you just let us know.

Gail Huckins:

One is kind of very niche on taper, so I don't know that it would fit JAVMA too well.

Sarah Wright:

That's fair. So these next set of questions are really important for our listeners. First one is what is one piece of information the veterinarian should know before discussing this topic with a client?

Gail Huckins:

Yeah, that's a really great question. I think the one piece of information that they should know is that GI stasis isn't a death sentence. I think for a lot of general practitioners that may not have a ton of rabbit experience, a rabbit comes through the door and it's very sick. They may say, like rabbits automatically have a poor prognosis of surviving, and this paper shows that that's not true. And, honestly, the treatment method that we're using too, it's not anything that your average clinic can't do. Most clinics have at least a fluid pump and a syringe pump, and that's really all you need. So I think this treatment options a lot more accessible to some people that might not be comfortable with rabbit medicine. So I would say that's the big thing GI obstructions aren't a death sentence and the treatment really isn't as complicated as they think it is.

Sarah Wright:

Thank you. And then, on the other side of the relationship, what is one piece of information that the client should know about using a lignite and CRI for rabbits with GI obstruction?

Gail Huckins:

Yeah, I think, like I said, it's a relatively non-invasive treatment. The medication is very safe. We didn't see any side effects in any of our patients, even at a very high dose, and we had a really good success rate. So a lot of rabbit owners are pretty savvy and cautious about potentially new treatments that haven't been reported before, but honestly, this one, I would say the number one piece of information is it's safe and it's effective.

Lisa Fortier:

Fantastic. Well, I've learned a lot, Gail. As you might remember, I'm an equine surgeon, so I'm loving this job and learning so much, and congratulations again on a really impactful manuscript.

Gail Huckins:

Oh, thank you. I mean, I always say that rabbits are basically tiny horses, so you know, they are fairly similar.

Sarah Wright:

I don't know if the words are out of my mouth. I'm going to say the same thing, Lisa.

Lisa Fortier:

I'll let that slide. Gail, a little bit earlier you talked about, like, your determination in changing this clinical problem. But in general, as a woman veterinarian through a residency, where do you think your resilience or determination came from?

Gail Huckins:

I mean, I think a lot of it came from I knew this is what I wanted to do. The second I entered vet school. So I always had zoo medicine as an end goal. So, you know, even starting in vet school, I knew what I wanted to do. I knew the steps that I had to do it. Not to say that you know it wasn't a long journey. I went through pretty rigorous internships and residencies, but I think having that end goal in mind really helped me, you know, push through. And then, honestly, a lot of it too is I had a really supportive family. My parents have always been super supportive of what I wanted to do and, you know, having that support group and friends from vet school that I'm very close with, just having that support group, really helps you push through.

Lisa Fortier:

Yeah, it's awesome. As we wind down, Gail, a little bit more of a personal question that Sarah and I love to find out what was the first concert that you attended?

Gail Huckins:

This is probably like not the expected answer, but the first one that I went to was actually a Maynard Ferguson. He's a jazz trumpet player. I went with my dad when I was in middle school, so a little random.

Sarah Wright:

I don't think we've heard that one before, so it's a fun question to ask. We got Metallica last week, so that's a good one.

Sarah Wright:

Allie and AJ from the Disney channel. It's also an answer. There's some fun ones, but just thank you so much again, Gail. We really appreciate your time today and for submitting your manuscript to JAVMA. You can read Gail's manuscript in print, JAVMA or on our journal's website. I'm Sarah Wright with Lisa40a. You want to thank each of you for joining us on this episode of the Veterinary Vertex Podcast. We love sharing cutting edge veterinary research with you and we want to hear from you. Be sure to leave us a rating and review on Apple Podcasts or whatever platform you listen to.

People on this episode

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Lisa Fortier, DVM, PhD, DACVS

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Sarah Wright, DVM

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