ileus

Question
One of my precious bunnies just passed away last night at the age of 6 and I just have to know if I did all I could.  She's a spayed fuzzy lop I rescued 5 years ago.  She and her mate met at the rescue org and came to me as a bonded sterile pair.  He's always happy-go-lucky and she's usually been more stressed and watchful -- never much of a cuddler.  They've not been caged and have both been fed a great diet:  organic non-gassy greens in a.m. + papaya tab and 1/16 cup (for each) bunny basics T; free choice of timothy hay all day and night; different non-gassy greens for dinner, another 1/16 C BBT for each, another papaya tab, and organic pineapple juice diluted with filtered water.  Both buns are fairly long hair and I was good at combing so as to avoid wool block.  But she started bloating at age 3 and wound up having gastric lavage twice.  Thereafter, she seemed to be prone to bloat and I became truly hyper-attentive about heading it off so that it never occurred - by SubQ'ing her every 7 - 10 days; making certain that both buns were combed daily; giving her a prophylactic and lesser dose of Reglan about once per week; and really watching her behavior, intake, and pooh.  In the last 3 years there have been no emergencies I couldn't handle and she's been as happy as I've ever seen her - often playing push-ball with me and dancing happily after her breakfast.  That's the history.  Yesterday, she didn't eat her morning greens, so I launched into my normal routine to head off the downward spiral:  65cc SubQ and Reglan.  Watched her for several hours - gave second dose Reglan and only dose of banamine.  These steps alone would normally have resolved her problem  and she'd be back to bouncing around the family room and munching hay on the hearth with her mate.  Afternoon came and she was still kind of withdrawn and not eating, and her tummy was a bit firm but not taut "with rocks" like a full blown emergency.  Gave her a third and final dose of Reglan.  At 5:30, her tummy was firming up.  At 6:40 we saw a local vet.  X-ray confirmed gas bloat and no obstruction. This vet had never done a gastric lavage - so opted for a needle extraction of gas, which did not release much gas.  Vet gave her .2 cc Buprenex at the time and returned her to me.  In relatively short order at the vet's, her tummy was nice and soft but she seemed doped and lethargic and not right at all.  I questioned if that was the effect of Buprenex and a tech said probably - as when it's given during surgeries, the animal recover less rapidly.  My precious bunny never recovered from this.  I called an emergency facility to see if she'd been given an overdose of Buprenex for a 4 lb bunny and they said no - a higher dose like .2 is OK in bunnies who metabolize so much more quickly than other animals.  I kept my baby warm and held her until she passed -- 4 hours after getting the Buprenex.  Please tell me:  was it just her time - or was the Buprenex a killer? The last does of REglan was given at about 2:30.  Was there a lethal interaction between Reglan and Buprenex when the Bupe was administered at about 7:00?  
FYI -- Her mate has never had a problem with ileus.  Was she genetically predisposed to be vulnerable in this way?  And speaking of her mate, he seems to be OK at this point, but should I hurry up and try to get him another companion?  I've heard awful stories about the mate left behind dying from grief.  Thank you so much for any insights you can provide.  I am just heartsick.

Answer
Dear Barbara,

I am so very sorry about the loss of your dear friend.

Sadly, it has been my experience that rabbits who have chronic bloat problems are pretty much "ticking time bombs" and it's only a matter of time before one of the bloat episodes proves to be the last.  You don't mention whether your bunny had other chronic GI problems, such as abnormally large poops of a soft, "marshmallowy" consistency, but bunnies with this (congenital) syndrome are usually more prone to chronic minor obstructions that scar the intestine and often lead to fatal bloat episodes when there's finally one large poop that just can't make it through a narrowed area.

Some rabbits also may be congenitally prone to suffer *gastric* bloat (i.e., of the stomach), which can occur when the very tight turn the intestine takes just posterior to the pyloric sphincter (the one that empties the stomach) is pinched off, either by gas or a stomach that's too full of food and other matter.

Your bunny is lucky to have survived *any* bloats, as most rabbits die from their first.  You must be an incredibly attentive and attuned bunny mom to have nursed her through this type of problem for so long--but it was a very sad battle that was inevitably bound to end this way, at least if my own past experience (and that of many others) is any indication.

Buprenex is generally considered quite safe for rabbits, and I really do not think it was the cause of her death.  In a severe bloat, we sometimes see the tummy become soft and the bunny appear to feel better, and then they just either fade away, or suffer cardiac arrest from some related problem that is not yet well understood.

I did a quick search for interactions between buprenorphine (buprenex) and metoclopramide (Reglan), in case there's something out there I wasn't aware of.  But all I found was what I already knew:  buprenex might inhibit the effects of metoclopramide to some degree, but there is no indication that there might be a fatal interaction between the two drugs.  

I think you and your vets did all you could to save her, but it really was just her time to leave.  

I hope you can take some small comfort in knowing that she knew you were there, holding her, making her passage safe and as easy as something like that can be.  And if she was on Buprenex, it is very unlikely that she suffered pain, since that is a very powerful painkiller that likely made her passage very gentle.

I know it's not much, but it's something.

She will always live in your heart, and in the heart of his mate.  If he seems okay at this point, and is eating well and not acting too depressed, then he's probably said his goodbyes (I hope he got to see her body, since rabbits do understand what a dead body is, and it helps them to find closure) and is ready to move on.

So when you are ready, you can contact your local rabbit rescuer and let them know that a little survivor needs a loving mate.  No one will ever be the sweet bunny you lost again.  But every bunny is a new treasure, and I hope whoever might come into your home gives you and your bunny's widower many years of joy.

Take care,

Dana