7yo Rabbit in GI STAIS - been to vet and need 2nd opinion

Question
QUESTION: Hi Dana, Thank you in advance (again) for helping me with this. I mailed you
a couple of weeks ago regarding Tater and the use of zithromax for her URI
and just as soon as I could finish reading your response, she was in full blown
GI stasis. Friday night 9.10, I took her into our urgent care, because I did not
see any droppings the whole day and she did not eat her salad (very rare). The
vet gave her some metacam, IV fluids, trimethoprim sulfate and a dose of
metoclopramide. She did not have a fever, i might add. The vet faxed the
treatment to my vet and we got in the next morning. Throughout the night I
was giving Tater Critical Care (which she loved) and I did see her eat some
more salad. I had stopped giving her the Zithromax the day earlier (9.9)...she
had been on 1.5cc for a month. At the vet, it was confirmed (without x-ray)
that Tater's belly was bloated and hard, but she could not feel any mass. She
did however, find some sharp points on her lower right molars. She gave me
more metacam (oral 0.4cc 2x/day), metoclopramide (0.36cc 3x/day initially),
simethicone (oral 0.2cc 2x/day), LR (100ml SQ as needed), probiocin 1g
2x/day), unswetenend pineapple and papaya juice (1.5cc 2x/day) and I am
giving her critical care as she will take it which has been about 20-30cc
2x/day. She has eaten some salad (dill, chard and collard greens) and has had
some tiny amounts of soft fecal pellets. MY MAIN QUESTION IS: The vet
wanted to get her right in this same week to file down her molar spurs, which
makes me EXTREMELY NERVOUS due to the fact that she would be using an
injectable anesthesia (ketamine) and then reverse it after the procedure.
Should I have her do this? I am worried on one hand, and on the other I think
that it will help her be able to eat again. She was always an excellent eater
and now she will not touch any hay. I see her wanting to, but then shies away.
She is obviously hungry, because she is begging for "treats", but I am not
giving them to her...too starchy. Her energy level is still good...for now. I have
been crying for 2 days straight and am fearful of making the wrong decision.
Are the juices okay to give her? Tomorrow (and all week) I have to be at work
from 6-2:30p and feel like I am abandoning her. I will give her some critical
care before I leave( along with her meds), but Is that too long to leave her
alone without force feeding her? I trust your opinion, please help. Thank you
so much, Rebecca & Tater.

ANSWER: Dear Rebecca,

Why is the vet using ketamine for this?  That's pretty...retro.  Our vets always use isoflurane gas (much safer), even for dental work, and keep the bunny on the gas with a tiny nose cone.  Since rabbits are obligate nasal breathers, this is not a major problem, and a dental filing doesn't take so long that the anesthesia has to be given for very long.

I am not a fan of injectable anesthetics (actually, ketamine is a dissociative, not a true anesthetic) in rabbits, and I would suggest you try to find a more rabbit-savvy vet who can do this with isoflurane:

www.rabbit.org/vets

or at least get a second opinion.

If you can get some Critical Care for feeding her, that would be ideal:

http://www.oxbowanimalhealth.com/vets/products/critical_care

It will keep her well fed and healthy until you can make the decision on the molar filing.

For more information on treating the GI stasis, please see:

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

but if she is eager for treats, I doubt she is in full-blown ileus.  I hope this helps.

Dana

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

QUESTION: Thanks Dana, I appreciate your advice. I do have her on Critical Care...she LOVES it. Her GI stasis is starting to reverse itself. When I came home yesterday, her whole salad was gone. Sometimes it's the little things in life... My dilemma was getting her in for the procedure more sooner than later so that she can heal and get on with eating hay. I guess it's a risk I am taking either way. If I don't do it soon, then she is in pain and will not eat any hay. No hay, no decent poop and spurs that keep on growing. I have called around town and have another rabbit resource and was told that ketamine was a common way to do the filing. The vet called me back and said that she will also use iso with oxygen over her nose. I have tried to become as literate as possible with all this in the past few days...my head hurts. I am also an anesthesia/surgical technician and just spoke to one of the Drs who said that ketamine is also used for pediatric cases and is quite safe....but they are also not vets. I feel better about it, but now that you said they should primarily use iso...I'm questioning it agin. I have scheduled her for Thursday am and will talk to the Dr beforehand just to answer some more questions. I am staying at the vets office while it's being done and will take her home to recover as soon as possible. Do you have any suggestions to help with this process? I would really appreciate it. I was also told that in an IDEAL world, x-rays would be taken and a dremmel used vs. a clipper. There are vets that do this, but they are both an hour away. I think if she continues to have dental issues (GI issues from dental issues) I will be making the drive and paying the $$$. Thanks again Dana :)  

Answer
Dear Rebecca,

If your vet is using the ketamine as a pre-anesthetic, and not the only anesthesia for this procedure, that's a bit more common.  Most vets I know have changed pre-meds to things like buprenorphine, and my own vet uses morphine (which I was worried about at first, but we've had absolutely fantastic results with it for major surgeries).

So if this is how they do things in your neck of the woods, and as long as your bun will have oxygen and isoflurane during the procedure to make sure all is well, then this is what you have.  You're right about just biting the bullet and having the filing done.  Once your bun is recovered, you'll be glad you did this.

I hope it doesn't become a chronic thing.  You can help by making sure she has plenty of fresh grass hay, and--if possible--access to live, fresh grass if you are absolutely sure it hasn't been sprayed with pesticides, fertilizers, or has any kind of contamination from wild animal waste or car exhaust (I know some people who have collected lush-looking grass from beside highways because it looks so nice, but it's *full* of nasty emissions by-products.)

Providing things like fresh twigs from non-toxic trees (I don't know where you are, but maple trees are good for this) will also help promote the side-to-side chewing that helps keep the molars smooth.

Hope all goes well, and that your bunny feels much better soon!

Take care,

Dana