stomach surgery

Question
QUESTION: Dear Dana,
Please forgive the length of this 'question', I know you are busy but felt I needed to give as much background as possible.
Ted, 7-8 year old lop, 3.6kg
Diet: very few pellets, lot of veg, variety of hay (but see problem below)
sheds a lot, grooms a lot.
28/4 off food, vet said teeth were fine, told him I had noticed 2 little holes in the rug, he might have ingested carpet fibres. given injections of Baytril, metaclopramide, metacam
started eating veg and pellets, virtually no hay, drinking more
4 weeks later...
sat 22/4 had eaten a bit of hay but didn't look right, drank a lot, also noticed he had eaten some paper, peed on floor, taken to emergency vet, they said he had a molar spur, injection for pain, sent home, told to see regular vet Mon morning
sun 23/4 no appetite, no weeing all day, could get a little wet herbs in but didn't look right, back to emergency vet, another injection for pain, told he had to stay overnight
mon 24/4 gone to 'rabbit specialist' to do teeth, did x rays of head and body, urine and blood normal, gut sounds not good, bladder ok, rectum and bowel normal faeces, small bowel gas filled, kidneys normal, said saw stomach twice the size it was supposed to be. 'gigantic fur ball'. Said could wait but then he would be in even worse shape if needed surgery so recommended surgery.
tue 25/4 surgery, removed fist size volume of food, hair, fibres, had to go back to hospital overnight, syringe feeding, told he was eating apple and parsley on Wed
thu 26/4 told ok to pick up, given Metacam and Baytril to give at home. at home looked miserable, pressed belly on floor, almost no appetite.
fri 27/4 noticed on invoice he had been given Metoclopramide but I wasn't given any to give at home. Took Ted to local vet for Metoclopramide injection and had to beg for Metoclopramide injections to take home (they don't have the syrup here it seems)
at home drank a lot (always does that after Metoclopramide injections, why?)
no appetite, started Critical Care every 4 hours
sat 28/4 pm ate a bit of kale etc. no hay, sits in toilet long time, looks uncomfortable, not relaxed
sun 29/4 some small droppings, some soft, some hard slime covered,
feeding bit of herbs every 4 hours, a few pellets, won't eat hay
mon 30/4 very keen on pellets but only gave a few, gave wet herbs, several times a day, droppings very small and hard, not drinking except after Metoclopramide injection which I was told should now be half dose (regular daily dose was 0.5ml), always pees on floor after injection whereas normally he uses his tray
tue 31/4 tiny hard droppings with sharp points, eating some greens, keen on pellets but only given a few, not drinking, tried mashed banana diluted in water but would not drink that either, kept trying different kinds of hay but would not eat any. tried hiding pellets in hay but he just picked them out. finally tried alfalfa which he did eat. still looks uncomfortable, perhaps especially in toilet and after eating a bit.
Questions:
1) I was told by the vet nurse that I was irresponsible for not restricting Ted to a small area. He should not have access to carpets and he should be surrounded by lots of hay. Do I have to cage him? Do I turn my living room into a barn? He has hay in two toilet trays at the moment. Of course in the last few days I have been following him around with a hay buffet tray...
2) Vet said no massage because of surgery. I tried a bit very gently anyway but Ted doesn't like it. He loves having back stroked but not belly.
3) Do I continue the Metoclopramide (half dose?)and Metacam (how much?) and Baytril? He also gets some Fibreplex.
4) Do I syringe feed water? Haven't done that since I'm trying to reduce stress...
5) Would simethicone help? Haven't tried that yet. Vet told me not to.
6) The cause - is it possible that he had dental pain which made him stop eating hay and this led to 'hair ball'? I feel absolutely awful I didn't do anything earlier, his droppings had been a bit smaller and there were fewer of them but no dramatic change. I stupidly thought he was ok since he seemed alert and happy most of the time and was still keen on pellets and veg.
7) I am thinking of changing vets. I will want to know that they can diagnose dental problems (and that they have the proper equipment i.e. that contraption with something like a digital camera on the end which my vet doesn't have). Any other questions I should ask them?
Thank you so much for reading to the end! I would really appreciate your advice, there is so much conflicting information out there and it's really hard to find vets who know about rabbits near me.
Diane

ANSWER: Dear Diane,
Questions:
1) I was told by the vet nurse that I was irresponsible for not restricting Ted to a small area. He should not have access to carpets and he should be surrounded by lots of hay. Do I have to cage him? Do I turn my living room into a barn? He has hay in two toilet trays at the moment. Of course in the last few days I have been following him around with a hay buffet tray...

Unless the bolus in his stomach was composed of carpet fibers, then there is no reason to think that allowing him on the carpet is a problem.  If he is a carpet chewer, it's another matter.

2) Vet said no massage because of surgery. I tried a bit very gently anyway but Ted doesn't like it. He loves having back stroked but not belly.

No tummy massage after a surgery like this.  

3) Do I continue the Metoclopramide (half dose?)and Metacam (how much?) and Baytril? He also gets some Fibreplex.

Follow the vet's directions.  You might also ask about enema to stimulate GI movement after a drastic surgery like this:  www.bio.miami.edu/hare/ileus.html  DO NOT ATTEMPT THIS WITHOUT CONSULTING WITH THE VET!

4) Do I syringe feed water? Haven't done that since I'm trying to reduce stress...

At this time, oral feeding might be risky.  Ask the vet about administering subQ fluids to make up for what he is not getting orally.  Hydration is critical to his recovery.

5) Would simethicone help? Haven't tried that yet. Vet told me not to.

It won't help if the gut is static.  The important thing is to reverse any GI stasis that's taken hold.

6) The cause - is it possible that he had dental pain which made him stop eating hay and this led to 'hair ball'? I feel absolutely awful I didn't do anything earlier, his droppings had been a bit smaller and there were fewer of them but no dramatic change. I stupidly thought he was ok since he seemed alert and happy most of the time and was still keen on pellets and veg.

As you can see here:

www.bio.miami.edu/hare/ileus.html

"hairball" is truly rare in rabbits, and I'm not convinced this was the primary problem.  Dental problems are far more commonly the trigger for this, as you can see in the article above.

7) I am thinking of changing vets. I will want to know that they can diagnose dental problems (and that they have the proper equipment i.e. that contraption with something like a digital camera on the end which my vet doesn't have). Any other questions I should ask them?

I think a second opinion is certainly in order, and I only wish you'd gotten it before the surgery.  I hope your boy will be okay soon.

Dana

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

QUESTION: Dear Dana,
Thank you very much for your fast response and your suggestions. I can't tell whether Ted is getting better or worse. He is alert and eats but I don't like the look of the tiny hard droppings.
Question 1: Should I continue to offer him wet herbs, hay and just a few pellets?
I would like to follow up on your suggestion of an enema and subQ fluids (I certainly would not feel competent to do this myself) but this would involve yet another vet visit and I'm worried about the stress. Of course if it's essential I will do it.
Question 2: How do I know whether we are at the stage where he needs to see the vet again?
It is very difficult here to get a second opinion. Vets operate like a cartel (!), they don't share notes and will only see you if you switch to them. Hence my question about how to know whether a vet is a good rabbit vet.
Question 3: My regular vet (not the guy who did the surgery) now admits he knows very little about rabbits. Should I just take a chance and switch to a place I know of where there is a vet who has house bunnies?
You said to ask the vet about medication but he doesn't seem to know. I had to beg for the Metoclopramide because it's 'policy' not to let clients do injections themselves...  
Question 4: Any suggestions on whether to continue Baytril, Metacam, Metoclopramide and in what doses?
Thank you!!!
Diane

ANSWER: Dear Diane,

> I would like to follow up on your suggestion of an enema and subQ fluids (I certainly would not
> feel competent to do this myself) but this would involve yet another vet visit and I'm worried
> about the stress. Of course if it's essential I will do it.

It's essential.  You should do it.  The sooner the better.

Question 1: Should I continue to offer him wet herbs, hay and just a few pellets?

Yes.

Question 2: How do I know whether we are at the stage where he needs to see the vet again?

If you can find a rabbit savvy vet, then the time is now.  No rabbit-savvy vet would have done a gastrotomy on him.

Question 3: My regular vet (not the guy who did the surgery) now admits he knows very little about rabbits. Should I just take a chance and switch to a place I know of where there is a vet who has house bunnies?

Check the listings here:  www.rabbit.org/vets

to find a rabbit-savvy vet near you.  It will be worth a drive.  In fact, a car ride's gentle vibrations may actually help his GI motility.

Question 4: Any suggestions on whether to continue Baytril, Metacam, Metoclopramide and in what doses?

Continue with them.  I don't know the doses he's getting, so can't really comment on them.  If you tell me his weight and the concentrations of the suspensions you're using, I can better help.

Dana

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

QUESTION: Dear Dana,
Happiness is perfect bunny droppings! I am so happy to report that Ted has recovered. I will now try to find a vet who knows about rabbit dentistry...
I was very much aware of your opinion on gastrotomy which is why I hesitated when the vet suggested it but he claimed 'he hadn't lost one yet' and Ted might be too weak to wait and see if anything else would work. I wanted to ask you whether there are any longer term effects of the surgery I should be aware of.
Many thanks again!
Diane

Answer
Dear Diane,

I am so glad your boy is fine!  Your vet must be very good at this, and I do know of one vet who claims to have had excellent results with this procedure.  So let's hope all goes well.

Unless he forms adhesions that interfere with normal intestinal function, your bunny should not suffer adverse long-term effects.  Let us hope for the best!

You're a great bunny mom to have nursed him through this successfully!

Dana