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Persistent abdominal spasms

22 9:47:07

Question
dorsal x-ray
dorsal x-ray  
Hi Dana,

My 3-year-old female 2kg lop has been suffering from abdominal spasms with slight gurgling noises (both very faint, I have to concentrate to hear and see them) for the past 5 days.

Her history:
she's infected with Pasteurella multocida with a secondary Staph infection-- multi-resistant to antibiotics, not treatable. It's in her upper-respiratory tract, she sneezes under stress and has one weepy eye (will come back to that) but otherwise has been fine. She was attacked by a fox a month and a half ago through the fencing of her run, she had half of one ear amputated. After the surgery, the left side of her face (same side as her bad ear) appeared to be pulled back slightly so she looks a bit crooked in the facial muscles. My vet said it might be linked to E.cuniculi, I have lots of rabbits, all carriers (so many are in general) but she hasn't had any mobility problems or head-tilt... after her op, she was brought into my room. I let her run free but she was really messy, didn't care much for her litter box. I don't know if she repeatedly sat in her own pee puddles, but she seemed to manage to get her hindquarters sometimes soaked in pee.
She sneezes from time to time with no discharge, especially when she's feeling stressed. She's been through a lot.

Problem:
Recently I had her caged because she was just too messy on my wooden floor, she still gets out a few hours a day, but she spends most of her time in her cage. I noticed she was scratching quite a bit last week, so I treated her with Stronghold for kittens (the best local treatment for external parasites, I'm in Switzerland), because a bunny in the next room had recently arrived infested with fur mites. So I treated her in the neck, normally she shouldn't have been able to reach it with her mouth. The next day she eat a bit less of her pellets (she eats lots of hay, 2% of her weight in pellets and some veg every day), and a bit less of her veg. She nibbled at some hay, but less than usual. I gave her some more pellets and veg, the next day it was almost untouched.
She was "in heat", as in her hormones were going haywire (bottom lifting and all), that probably didn't help, but she became irritable.
I cleaned out her cage and put in a towel instead. Her faeces were normal, her pee as well (no deposits). But she still wasn't eating much. I took away pellets and veg and left her with hay, filtered water and hay-pellets (100% mountain hay, they're very yummy), she had 2 of those (they're about 1.5cm long and 7mm thick), and continued to nibble at some hay, but still, just not as much as usual.

I sat and just watched her for a long time and noticed little waves while she was sitting, in front of her thighs, and gurgling sounds, but very discrete. So I thought "colic", at least that's how you call it in French. But usually they have some sort of GI unbalance, i.e. diarrhea or illeus, of which she had neither.

My usual vet is on holiday, so I consulted the French equivalent of rabbit.org's forum. They said hay and water, and metacam (NSAID and pain killer) for the pain. I didn't get the metacam at first, but when I called my vet's office, the assistant told me he was away, and suggested I give her Benebac. So I got some Benebac, gave her a SnuggleSafe and continued to feed her hay, hay pellets and I gave her some bio chamomile tea to help with the pain naturally.
After 3 days, she still had the same symptoms: spasms, gurgling, grumpiness and diminished appetite, I had been treating her as mentioned above.
On the forum they said it's weird that she has no diarrhea or illeus, it might be in the urinary tract, I should have her x-rayed to see if she has a stone somewhere. They said give her metacam to help her manage the pain so I did, and I had to give her a few normal pellets before because it's not good to give it them on an empty-ish stomach.
I had no choice but to take her to my local vet the next day, she's not specialised in rabbits, but I assumed anyone could do an x-ray. I ended up seeing the newbie vet, she took a long time to do the x-rays, told me she was surprised by the blurred appearance of the organs in the abdomen. I found out by a specialised vet on said forum that it's normal in healthy-weight rabbits who've been eating regularly. She doesn't have much time to help me however, that's why I'm here.
Anyway, it was clear for any urinary tract problems. No sludge to be seen, no stones, not even any gas really (so the newbie vet said). She thought the blurred x-ray meant peritonitis, but I learned afterwards that as I said, that is the normal appearance of a rabbit's abdomen. So all she did was freak me out. She also took her temperature, which was normal, but she said the metacam might have brought down a potential fever, she told me to take her temp without the effect of metacam, but I haven't been able to get a thermometer yet (that was the 9th). She called a specialist vet miles away, he said it was very unlikely that it would be peritonitis without any diarrhea or illeus and such a good clinical exam. He couldn't see my rabbit, but his colleagues (not specialised, but apparently fairly knowledgeable) could in the PM the next day. She injected her with an antispasmodic drug and said it should help (it didn't, the next morning she still had spasms). The forum said I should consult with those other vets so I took the x-rays and travelled miles in public transport to see them the next day, the 10th. They took me in 1h late for a 3minute consultation. He checked her teeth which were fine, and asked about her stools which I told him were normal. He said "You know, rabbits have colic like horses do, they get knots in their intestines and sometimes it fixes itself, sometimes it doesn't and you have to operate. However, operating on the GI tract is tricky and risky in rabbits (that I know)." He gave me 2 more antispasm. injections to give her myself and to call him on Monday with news. I asked what about the x-rays? He said "If the other vet didn't see anything, it's not worth it. (the other vet is the more senior vet who put together the x-ray CD for me, after having told me they looked normal to her)." I asked "She's been on hay for 5 days now, do I still keep her on a fiber-only diet? Won't she weaken?" He told me to give her sugar-water. Blech, not doing that. He also suggested Rongeur Digest, which is basically a commercial "magic powder" pro-biotic that doesn't really help.

I left the clinic kind of angry, I was expecting more info, more answers after such a long and stressful journey for the both of us but there you go. I'm still at the same point: I'll give her the antispasm. drugs in sub.cut. and I'll keep going with the metacam because she's visibly in pain (she'll be lying on her side then she'll jump up in pain and will start licking her tummy). I'm also continue with the Benebac which contains live micro-organisms that are naturally present in the GI tract and help keep it running smoothly if there's an imbalance. She'll have 1/4 of her pellet ration to be able to take her metacam, otherwise she'll be kept on a fiber diet. I'm getting some Critical Care tomorrow to help get her her nutrients and energy.

My questions are : what does she have, why does she have it, why is it lasting so long, how should she be treated and when will she get better? And am I doing it right ?
I've been going around in circles and I'm fed up with it, fed up with causing her so much stress. She whines now when I approach her cage, afraid of another trip to see some smelly stranger, it takes 5 minutes of stroking to have her calm down and start purring. My vet is gone for the week and no one seems to know much or what to do.

Sorry this is really long but at least you have all the details.  I just don't really know what to do.
I'll attach the x-rays; her appetite seems to have slightly improved, but the spasms are still there with the gurgling sounds. I'm reluctant to go back to her normal diet while she still has these symptoms. But there was never any diarrhea or illeus or stasis, normal faeces production, I even watched her eat some caecotrophes today. Seems well-balanced.

Thanks you for your opinion, I can never have too many different POVs !

I have a right- and left-side and view x-rays, but I can't upload more than one...

Answer
Dear Emilia,

The radiograph looks unremarkable to me.  Not much gas; tummy is full and intestines full.  

I have to wonder if the apparent spasms are a Red Herring.  A healthy rabbit who is very lean will often have very apparent peristaltic movement of the intestines, especially visible when the bunny is lying down in a stretched out position.  It almost looks like snakes in the belly!

While I don't doubt she may be having abdominal pain if she's jumping up and licking, I'm  not so sure the peristaltic movements have anything to do with them.  Maybe yes, maybe no.  Very hard to say for sure.

If this were my bunny, I would be scratching my head and thinking..."What can I do to alleviate any inflammation of the intestines that might be causing this?"

Here are some suggestions:

1.  pediatric simethicone suspension (for gas)
2.  Barium (which actually soothes the GI tract)
3.  sulfasalazine (can very quickly soothe an inflamed GI tract)
4.  Questran (to adsorb any substances that might be causing inflammation)

If she is eating, then the condition is not severe. I wish I could see a video to judge her behavior.  Is it possible for you to take a well-lit, clear video and upload it for viewing on YouTube?

Dana