Rabbits - Sludge - URGENT - is it really a death sentence?

Question
Dear Dana,
I know - it is a long shot to ask you now - since I have only a few hours left to decide what to do. It's just that I am so truly desperate for answers!

My male rabbit about 4 years - normally enjoying his life - has suddenly fallen ill with, what turned out to be a lot of sludge in his  bladder. The vet (who we never met before) tried to extract it - but told us, we had two options - surgery in the morning or putting him to sleep. She claims that he will be suffering from sludge again - and that it would be cruel to let him go through such an ordeal. (for no reason)

I have tried to read up as much as I possible since we got home from the vet - but I cannot figure out what to do. My boyfriend and I would love to give the little one a fair chance - he's our baby - and he recently lost his beloved spouse, and had started on really promising bonding sessions with a new female. He didn't seem to lack appetite for food, water nor life until two days ago. HELP! IS there any hope? It seems impossible to find a rabbit-savvy vet in my country.

I gather that it may NOT be due to a high calcium diet  after all - (though I can tell many of his faves are on the higher end of a list I found on HRS. We also have very hard water here - which has made me  consider to change to rainwater.)

changing the diet is doable - but what can we do, if it is due to metabolism...?

And also I am a quite worried about him having to undergo surgery to remove the sludge...

Sincerely,
Mia

Answer
Dear Mia,

Short answer:  NO, this is not a death sentence.  I'm sending this immediately so you won't make an decisions you'll regret.

But I hope you can find a vet who is more experienced with rabbits:

www.rabbit.org/vets

Bladder sludge can be gradually removed with subcutaneous fluid therapy and gentle agitation and massage of the bladder to suspend the sludge and get it into the urine.  If you do this with the bunny in "cradle" position, it also helps get the sludge off the bladder wall.

Having the bunny "stand" (with front paws on your arm and back feet flat on a towel or mat on the table) while you gently express the bladder also can get a LOT of that guck out.  You just need patience and gentle hands.

Unless there is an acute blockage of the urethra, this is not an emergency situation.  A bladder *flush* can sometimes be tried, but this is risky if the bladder is already full of sludge and the walls of the bladder possibly inflamed.  A puncture could be fatal.

Surgery is another option, but I would resort to this only if there is an acute blockage with no other choice.  Otherwise, careful, constant therapy as described above can remove a LOT of sludge over the course of several days.

Pain management is vital, of course.  And if the bunny is in enough pain that ileus is a side effect, then you might also need this information:

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

I hope this helps, and that your bunny will be well soon.  But unless he cannot urinate at all, and his bladder is backing up, I would not try the surgery just yet.  An experienced rabbit vet can show you how to express the bladder, but just gentle agitation and massage of the bladder an hour after subQ fluids can make a HUGE difference.

Dana