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URGENT HRS sick bunny already been to vets

22 9:53:38

Question
QUESTION: Hi Dana I am a volunteer with New Mexico House Rabbit Society and am trying to help an adopter with their sick rabbit.  The rabbit has been to the vet 3 times already and then another vet for a second opinion with still no results.  I am hoping since you speak with so many people you will have heard of a similar situation and can provide some information.  I suspect we dont have much time before we lose the bun.  About two weeks ago the rabbit urinated on himself and was refusing to eat so we knew there was a problem.  It was late at night so we ourselves administered SQ fluids and force fed and in the morning took him to emergency since it was a weekend.  They took xrays and bloodwork.  Xrays did not show a blockage and when bloodwork came back all was fine except for elevated WBC.  They suspected an infection.  He has been on antibiotics and GI mobility drugs and for the two weeks continues to get SQ fluids twice daily simethecone drops and pain meds.  He is eating his greens but no pellets or hay at all.  Here is the doozy he has not pooped for the entire two weeks except one small misshapen clump.  How is he still alive?  He appears well except for the fact that he is not pooping.  He has all our volunteers as well as local vets stumped.  Any fresh ideas would be greatly appreciated.  He has another vet appt tomorrow morning (Sunday) but as I mentioned I know we are running out of time.  Thank you so much for any help you can provide.

ANSWER: Dear Victoria,

A little more detail will help me help you figure this out.

1.  What antibiotic(s) is he on?
2.  What gut motility drug(s) is he on?
3.  Any other medications?
4.  Has anyone had a look at his teeth?  (There could be more than one thing going on here)
5.  Has anyone taken his temperature?  (This is critical; you can find instructions for how to do this here:  www.bio.miami.edu/hare/sickbun.html )

As far as his poop production:  I've seen bunnies go even longer and still recover.  So hang in there.  Seriously, I've found that the single most effective combination for getting the GI tract running again is:  (1) shallow enema and (2) gentle tummy massage, both with kneading hands and electric vibrating massager.  You might already have seen this, but a lot more information about treating ileus can be found here:

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

You are doing all the right things, and palliative care can buy a LOT of time.  If the bunny is eating a little bit, then his GI is not completely shut down.  It's moving a little.  Just sluggishly.  Oral hydration is important for keeping things moving through the pipes.

But try that enema.  You will likely see amazing results.  Listen to the gut just before the enema, and then again about 2 minutes later.  In almost every case, you'll here things start to gurgle away. This often works incredibly well alongside GI motility drugs, which KEEP the GI moving once the enema has started things up.

Hope this helps.

Dana

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

QUESTION: Ok here is the rest of the information you requested.  .7ml Reglan for mobility, .57ml sucralf for mobility, .15ml cisipride for mobility, .05ml butorph for pain, 1ml simethicone for gas, .2ml enrofloaxcin as antibiotic, and a tinsure of 5drops dandelion root and milk thistle for liver function. His temp changes sometime low sometimes normal last check was normal.  His teeth were good.  Here in New Mexico we are a new chapter for the HRS and we are a small group of volunteers but we are all extremely dedicated and ban together when one of our rabbits is in dire straights.  I cant express my gratitude for your help with this particular bunny as he was my foster before the most perfect mom found him.  She hasnt had him for long and she loves him dearly I want them to have a long happy life together.  Thank you so much for responding so quickly.

ANSWER: Dear Victoria,

Well, he's on all the good gut meds.  (just fyi, sucralfate isn't for motility; it's to serve as a sort of chemical "band aid" in case of intestinal ulcers)  But still do consider the shallow, lukewarm enema to help kick start his GI.  It really can work wonders.

Now.  If this were my bunny, I would ask about adding another antibiotic, and specifically dual-acting Penicillin-G Procaine (brand name is sometimes Bicillin, but there are many brands).  If this is a tooth problem, this particular antibiotic can really help.  

The sudden urinary problem is a concern.  Has anyone mentioned culturing the urine?  (This can be dicey, as it seems many urinary tract bacteria are anaerobes and extremely difficult to culture.)  If a UTI is suspected, then an aminoglycoside antibiotic along with the current fluoroquinolone (Baytril) might be something to ask the vet about.

If your vet is not completely against using NSAIDs, then I would highly recommend Banamine for a case like this.  It is a *powerful* analgesic--I've found it to give startlingly better results than metacam--and particularly for a bunny with abdominal pain.  Sometimes it can really turn a situation around.  If the vet is concerned about the risk of ulcers, then ask about using famotidine or raniditine alongside, to reduce stomach acidity.  

Let's get this bunny well!  :)

Dana

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

QUESTION: Hi Dana.  I am sorry to say but we lost the little guy.  Actually the owner decided on euthanasia when we were informed by the vet that the bun was in pain and suffering.  HRS paid for this little guys necropsy and we have received the preliminary results.  With all your knowledge in this field I was hoping to send you a copy of it to see what your opinion of it is.  I attemped to attach it here but it was not allowing me to even though it is not copyrighted.  If there is another way for me to send it to you please let me know.  Thanks so much for all your advice.

Answer
Dear Victoria,

I am so sorry.  Sometimes even the most heroic measures will not save a bunny who has something very serious, if cryptic, going on.

If you would like to send me the report, you can email it to me at hunhare@gmail.com

Please extend my condolences to the bunny's family.

Take care,

Dana