low heart rate

Question
QUESTION: Dear Lee,
Ted, lop, 7-8 years old, 3.4 kg. , had a gastrotomy on 25th May. Nobody knows for sure but I suspect this episode was caused by dental problems leading to little hay eating. He had his teeth filed the day before the operation. He was in a terrible state for a while and I thought we were losing him - had to syringe feed, inject Metaclopramide, etc. Amazingly he seemed to have recovered after about 10 days and ate hay and produced good size droppings. In the last few days he is back to hardly eating any hay and being a bit picky with veg and producing few small droppings. I thought it was dental problems again (he was making chewing movements without food in his mouth) and brought him to the vet this morning. I was told that his heart rate was abnormally low (200)and he had lost a lot of weight in just a few days and he needed lab tests and 'ECG Xray scans' (?) and they would not do the teeth until they thought it was safe. Do you know what could be causing this weight loss and low heart rate? Is it serious?
Probably unrelated but I am having my living room painted so I had to move Ted to a different room a couple of days ago but he seemed to have settled in there ok. He is a house bunny (no cage).
I am terribly worried and upset, I'm very attached to the little critter. Any words of advice or explanation would be much appreciated.
Best wishes,
Diane

ANSWER: Hi,

it seems that the move may be the critical thing.  It seems to coincide with when he started eating less.  It may just be extra stress on top of all the other things that have given him tremendous stress the last couple weeks.

Key rule of thumb is for a recovering bunny, do not add any extra stress that is avoidable.  If you could have put off the painting a couple weeks it probably would have been better.  Basically the world as he knew it was pretty much all changed on him.  

Key thing is to spend more time with him, syringe feed him, make sure he is hydrated.  If he is still on pain meds keep him on pain meds.  If he's still on post op antibiotics keep them up.  As his appetite is dropped you may want to give him 1/4 tablet of Bonine (go to walgreens and get it) - must be Bonine (meclizine) every 12 hours until his appetite picks up and he is eating well.  He will need his teeth checked regularly.  You might want to get a little alfalfa hay temporarily to give him to keep eating and eating hay to wear the teeth down.  If he's not drinking 2-4 ounces a day you may need to put a little grape juice in the water (change several times a day) or if you know how to do sub-q fluids, do that.  A vet or vet-tech can teach you how to do that properly and you can get supplies for that from the vet too.

I'd avoid all sugary types of treats except a few little papaya pieces a day.  Papaya is good for the stomach, it stimulates digestion and helps dissolve any mucus buildups in the stomach.

Make sure the room he's in is cool and paint fumes aren't getting in there.  I'd try to move him back to his normal surroundings as soon as physically possible.

---------- FOLLOW-UP ----------

QUESTION: Dear Lee,

Thank you very much for your fast response.

Ted had not been on any medication for about a month and was doing well. He started eating less hay a few days before the move so I doubt that's the cause. Actually, I find it hard to get him to eat hay at the best of times (other than alfalfa) although I have tried a number of different types of hay... I don't think he was terribly stressed from the move, I moved all his toys and the rugs and some of the furniture etc. and I did spend a lot of time with him in the new room and he seemed relaxed there after a little while. I suspect it is dental problems again...

I have meanwhile heard from the vet that his tests (heart, blood, blood pressure, etc.) were all normal. He is staying in the hospital and will have his teeth done in the morning although the vet expressed concern about the weight loss but I didn't feel we should wait. I really hope that is the right decision, and that he will be ok and we don't get worse gut problems.

I do think he doesn't drink enough although if they get wet herbs and vegetables perhaps they don't drink? The vet didn't seem to think that he was dehydrated but aren't small droppings a sign of dehydration? I would feel very uncomfortable about administering subq fluids myself. Also think it's unlikely the vet would let me do that. I have tried adding juice to the water but he still doesn't drink it.

Did you suggest the Bonine (meclizine) as an appetite stimulant?

I am really confused about the proper diet for him, there is so much conflicting advice out there. I read that pellets should be treats and they should eat hay and vegetables. Actually my first bunny had several episodes of stasis until I stopped feeding pellets altogether and he was healthy for the rest of his life.

One final question if I may, do you recommend scheduled teeth filing for bunnies with molar spurs? The vet seemed to suggest doing this every 6 weeks... Given the stress and the potential stasis problems (not to mention the cost!) associated with dentals is it a good idea to do this routinely or wait until there are signs it needs doing? Ted is going to have skull x-rays tomorrow - will these reveal whether filing needs to be done on a routine basis?

Many thanks again for your help.

Best wishes,
Diane

ANSWER: Hi,

what I am saying is that he was already stressed from the vet and surgery, and even though he was doing better and dipped before the move, the additional changes probably didn't help.

A heartbeat of 200 isn't really that low considering 230 is in the normal range.  Heartrate really isn't something to worry about unless they aren't moving and are obviously sick.  Better indicators are are they moving normal, eating and drinking normal, excited for food like normal, poops are big and normal, etc.

If his teeth need work then they are most likely hampering his ability to eat.  They could be causing pain in the mouth/gums and by correcting this he will be able to eat more pain free.  If he is in pain, he should be given metacam, and if the vet finds that the molar spurs have caused cuts/abcesses in the mouth, tongue, gums, then he should prescribe metacam to keep your boy's pain levels managed so he will eat on his own.  Metacam is flavored and most rabbits take it well from an oral syringe.

Bonine is for appetite stimulation.  1/4 tablet every 12 hours.  However again if the reason he's not eating is teeth problems once this is corrected you may find you won't need to have him taking the bonine very long.  Also note the walgreens brand of Bonine is cherry flavored tablets, so they are generally well taken by rabbits.

Diet recommendations are general guidelines, some rabbits due to unique problems may require mods to that.  Hay is the biggest thing they should eat for best gut health.  It is what they are designed to eat.  Next is greens.  Only a few (not many different ones).  Romaine, green leaf, and italian parsley are the best.  Low in calcium and parsley is great for digestion and rabbits generally love all three. Plus htey are low in gas.  generally 1/2 cup of greens per day per 5 pounds of body weight.  Next is pellets.  General guidelines are 1/4 cup per 5 pounds body weight, per day.  You can space them out 1/8 in the am, 1/8 in the pm.  Just straight food pellets without extra junk in them.  Oxbow is generally recommended as the best.  If he's not eating that well you can always mix some alfalfa food pellets in to entice him to eat more.  

As for the teeth filing, generally once a rabbit has teeth problems, they are chronic problems and will require treatment periodically, for the rest of their lives.  Teeth problems do not go away unless the teeth are removed.  So yes, if you kind of see the interval of when his eating drops off, schedule teeth exams a little shorter than the interval in which he starts to stop eating.  In some cases the problems occur at less frequency as time goes on.

I would also ask your vet to make sure he's not suffering from infection as sometimes when the body is sick, depending on where the infections are (and in my guess it may be in his head area due to the teeth issues) they can affect a rabbit's appetite.  Also if he was not given post-op antibiotics as a precaution of prevent post-op infection, I would strongly ask him to check for infection.  Lots of things are kept in check by a healthy immune system but after surgeries and such when the body is weak and rebuilding they can sometimes get a foothold.



---------- FOLLOW-UP ----------

QUESTION: Dear Lee,
Thanks so much for all of this advice. You are a saint!
I am aware it's not ideal to move bunnies but he's been with me for 6 years and at some point you gotta paint...
Ted was of course given painkillers and antibiotics after his major surgery but I will ask about infection. He didn't have fever.
I came to the same conclusion about the heart rate - all info I could find said 130-325 is normal. So why did the vet do all those ECGs and other tests which are not only expensive but very stressful??? Ted was moving around fine and didn't look sick. The only reason I took him to the vet is because his droppings were small, he wasn't eating nearly enough hay and I thought he needed a dental.
Sorry about all these questions but this one kept me up all night - is it possible that Ted has formed adhesions (surgery was on 25th May and he did produce good size droppings for a while and didn't look like he was in serious pain) which are causing these problems? That would be a nightmare scenario. I can't bear the thought he would have to go through another major operation.
Many thanks!
Best wishes,
Diane

Answer
Hi,

I don't know why the vet focused on the heart so much, you'd have to ask him/her the reasoning.
I would suspect he may have thought stomach blockage and was concerned the lungs and heart were physically getting compressed and not working right.  They are all under the rib cage and if the stomach enlarges the heart and lungs can really get compressed.

It is possible adhesions have formed but that's not the more obvious problem and doesn't fit your described symptoms.  the obvious problem is the teeth causing problems that keep Ted from eating because of pain.  Look for the obvious.  You have a bunny you know has had these problems.  He will continue to have teeth problems.  Going from eating to not eating is a classic mouth problem sign.  You know you've had a hay issue with him, this compounds the teeth problem because hay is needed to wear down teeth.

When you hear hooves, think horse.  Not zebra.