calcium in bladder?

Question
QUESTION: Hi Dana

Just now I happened to visit your profile.  I didn't realize that is how the ratings and comments are used.  That helps me to understand the value of the comment portion.  

Also I read your answers to some of the questions on the profile page.   You mention that rabbits are high maintenance pets.  I think that discovery was the most surprising thing I
learned after first getting rabbits.   Of course if you get rabbits put them outdoors and do not invest time and energy into their lives, health and well being they are low maintenance.  They
are also short lived.   I don't think many people even realize that.  They might think 2-4 years is a nice long normal life time for a rabbit.   But I digress, let me return to the matter at hand,
calcium in the bladder and blood in the urine.

My questions concerns my rabbit that still has the ongoing problem of blood in the urine.  I tried again to see how he would do if I lessen his metacam dose.  Pretty quickly blood shows
up.  Pretty quickly it disappears when I increase the dose.

I finally was able to chat with the vet who did the ultra sound and urine culture, which were both clear.   Nothing stands out in the ultrasound. No bacteria cultured in out.  The vet wanted
to touch base with an exotic vet to see what his take was on it.  He did not think it was cystitis, which I think in this context refers to idiopathic inflammation of the bladder.   What they
came up with is the belief that the rabbit may have  to much calcium in his urine is having difficulty excreting it from the bladder.  

I did ask about the possibility of a bacteria that is difficult to culture.  I thought treating that might be less invasive than trying to do a bladder flush.   The vets response is that the  
bacteria found in rabbits generate cultures when cultured.  The failure to culture a bacteria is not seen as an issue in rabbits.  For this reason it is not considered.  If a culture fails to reveal
a bacteria it simply means there is no bacteria.   

Regarding calcium the vets recommendation was to remove most or all dry pellets from the diet.  Feed fresh greens but avoid the kale and cabbage type greens.  Encourage the bunny to
drink more water.  We might have to do a bladder flush.  We may have to do sub-Q fluids.  We might need to do another urinalysis.  She requested to see the x-rays to see if there is an
indication of calcium in the urine.   Also the urinalysis does show some crystal and calcium in the urine.  Not an unusual or surprising amount to the vet who first saw my rabbit.   Anyway
the second vet now has all of the tests for her review.    I will probably talk with her at the first of next week.

I have trouble thinking my rabbit has a lot of calcium in his diet.  Yes, he does get dry rabbits pellets.  Which he loves.  Some of it is alfalfa based.  I can easily eliminate the alfalfa and just
give the timothy.  He gets a lot of hay that includes orchard, timothy botanical, oat, and a very small, if I could measure it, like a tsp of alfalfa hay.   The alfalfa hay only recently to get him
back to eating.    I admit I got a little frustrated in the conversation.  I am not convinced it is the food/diet.

FIRST QUESTION; What do you think on the diet part and calcium?   It would be easy to pull the alfalfa pellets but I am not sure about pulling all timothy pellets.     This is a 10.1 pound
bunny.  Prior to all of this he received 1/2 cup of dry pellets a day.  The rest was hay, some fresh greens and pumpkin.    I increased his pellets to a cup a day to help him regain some
weight.  I can cut back.  

I remembered after talking with the vet there is a potential cause of calcium in my rabbits diet.  It is not the food.  It is the water.  We have hard water that does have calcium in it.   
2ND QUESTION; I have heard that if you use distilled water for drinking it pulls/flushes  the minerals  from the body.  Ever heard of that?

THIRD QUESTION; is regarding the possibility of calcium in the bladder.  What is a bladder flush?  What are the pros and cons of a bladder flush.  My first concern when hearing about this
is my regular vet had great difficulty attempting to use a catheter on another bunny.  She did not force it thank God.  The bunny was sedated at the time but she was not able to do it.  It
just seems the bladder flush would require a catheter.    I think vet currently trying to figure out what is going on also mentioned the possibility pulling the urine and calcium out via a
syringe and than giving sub-q fluids.    

Part of my frustration is I feel with each test and visit I end up with more questions and no answers.  There are so many possible directions to move in.  I am not convinced we have ruled
out a urinary tract infection, or a tumor in the bladder,  possible tumor in the urethra that was missed or would not show up on the tests done, or possibly even a stone that doesn't show
up on tests.    We have added a new possibility.   It is difficult to decide what is the best direction to move in.    I think both vets that have seem my rabbit are good vets.   The only real
frustration I have had with them is their reticence to consider suggestions by me.   I think the suggestions warrant consideration whether they come from a group like etherbun or just me.    
If we can not find a cause and the path I am suggesting we explore does not cause harm why not explore it.  

FOURTH QUESTION; considering tumors or stones not seen on radiograph any other symptoms to look out for.  Also can you tell me a little bit more about the stones and tumors that
don't show up on x-rays.  How do you find them?  

FIFTH QUESTION; What happens if it is a urinary tract infection that goes untreated?   What might be the next signs?   I have not tried the metrodianazole yet.  I may do that, but I doubt I
would have any vet support.   From everything I am hearing on it Metro.... sounds safe.    


So far the best thing I have done for Connors my bunny is keep him on metacam.  One of the vets was concerned about that causing kidney failure.  Maybe it will, I don't know but taking
him off metacam I feel certain will kill him.  A bunny that doesn't eat usually doesn't live that long.   My only concern on the metacam is it is only treating a symptom and not the cause.
I am concerned about the cause.

Thanks

Terri







ANSWER: Dear Terri,

"The vets response is that the  
bacteria found in rabbits generate cultures when cultured.  The failure to culture a bacteria is not seen as an issue in rabbits.  For this reason it is not considered.  If a culture fails to reveal
a bacteria it simply means there is no bacteria."

This seems like a silly tautology to me.  Fact is, we do not KNOW if anaerobic bacteria can cause urinary tract infections in rabbits.  For your vet to assume this without data is...unscientific.

But whatever.

FIRST QUESTION; What do you think on the diet part and calcium?

I am not a big fan reducing dietary calcium in an effort to control calcium metabolism problems.  Sometimes this can do more harm than good.  If the bunny needs high calorie food to maintain weight, then pellets are even more important.  Very few vets experienced with rabbit urinary tract problems believe that reducing dietary calcium is the answer.

2ND QUESTION; I have heard that if you use distilled water for drinking it pulls/flushes  the minerals  from the body.  Ever heard of that?

Yes.  It's a terrible idea.  It will mess with his electrolytes and make things even worse.  The problem is not excess calcium in his system.  The problem is that he is unable to metabolize it properly. That is, if he has actual bladder sludge, which hasn't been established.

THIRD QUESTION; is regarding the possibility of calcium in the bladder.  What is a bladder flush?  What are the pros and cons of a bladder flush.

A bladder flush involved inserting a sterile catheter through the urethra and into the bladder, and then injecting sterile saline into the bladder to wash out solid matter, such as calcium salts.

Pro:  Quick fix to the sludge problem
Con:  Danger of perforation; sludge will likely return; the usual caveats about anesthesia

"I am not convinced we have ruled
out a urinary tract infection, or a tumor in the bladder,  possible tumor in the urethra that was missed or would not show up on the tests done, or possibly even a stone that doesn't show
up on tests. "

I agree with you.

FOURTH QUESTION:  Also can you tell me a little bit more about the stones and tumors that don't show up on x-rays.  How do you find them?

Ultrasound or exploratory surgery.  The former certainly would be better.

FIFTH QUESTION; What happens if it is a urinary tract infection that goes untreated?   What might be the next signs?   I have not tried the metrodianazole yet.  I may do that, but I doubt I
would have any vet support.   From everything I am hearing on it Metro.... sounds safe.

Has he been on *any* antibiotics yet?  The aminoglycosides are excreted directly through the kidneys, so amikacin might be something to try, as long as it's given with plenty of subQ fluids (to avoid insult to the kidneys).  Metronidazole is relatively safe for rabbits, but it's a heavy-duty antibiotic that can cause GI signs and a few other side effects.  We've never had any problems with it, but usually don't keep the bunny on it for more than 5 days.

I hope you can get to the bottom of this and get poor Connor well!

Dana


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

QUESTION: We did do an ultrasound and did not find any stones or tumors in the kidney
or bladder.  Does that rule out stones and tumors in those areas?

We have not be able to get a look at the urethra itself.  

At this point I am wondering if getting a blood panel on the kidneys might be
the next step?

At least that will give us a base line and show weather or not there is any
current problem with the kidneys.

I can get the metro and dose for 3-5 days.  I don't need an rx to get it.  

I wonder if a UA is even helpful considering the culture was not helpful in
identifying anything bacterial?   Just trying to figure out what the most helpful
next step might be.

Terri

Answer
Dear Terri,

You have been referring to the bunny as "he", but I think I might need to ask what might seem a silly question:  are you absolutely sure of the bunny's sex?

I just realized that in all this, you have not told me if the rabbit is spayed or neutered.  If not, and if the bunny is female, then the blood in the urine is most likely uterine in origin, and she may have a uterine adenocarcinoma that needs to be removed ASAP.  This is *VERY* common in unspayed females:

www.rabbit.org/health/spay.html

Blood in the urine is often the only sign of uterine cancer in a rabbit, but it is very important to have the bunny spayed ASAP to prevent metastasis.  Vet might wish to do radiographs to check for mets to the lungs (most common site), but if all is clear, then spaying will often provide a lifelong cure.

Hope this helps.

Dana