Frequent gas pain attacks

Question
Hi Dana,

You may re-call I have an elderly bunny (9 years old) who receives regular dentals for molar spurs etc.  I changed my vet recently because he'd been prescribing very high doses of metacam.  He put my bunny on daily metacam to help with cramping condition of tooth roots and to see if it would improve eating.

After a recent dental with my previous vets, he upped this rabbits pain relief dosage of the metacam to 1ml twice daily for 5 days and then to 0.4ml twice.  My rabbit was miserable after this dental, never regained eating properly and although I did not do these high dosages, she had received more metacam in the last few weeks than she had ever before.  Two weeks on from that dental, she had gas pain following a dose of metacam.  Although I can't say it was metacam for sure that caused it, I suspected it could have, or she may have possibly been developing an ulcer, it seemed like she'd had post-op dental pain too.

A new vet spotted bruising to the cheek and is concerned there may be kidney damage so is running blood tests.  My rabbit was also put in for a dental on the day she spotted the bruising.  The vet uses hypnorm for the GA, my rabbit had previously been on domitor, ketamine & torbugesic, the vet said she was concerned about all the GA's she'd had also as she said Domitor lowers the blood pressure.  She used metacam in the pre-med and also on the same day as dental, she gave an anabolic steroid called 'laurabolin'.

That same day as the dental, my rabbit came down with gas pain that night.  My concerns are, could my rabbit have a stomach ulcer, could these meds be causing all this gas, it seems very coincidental that she develops gas pain on the same days as certain meds are given.  I can't find any info on Laurabolin and rabbits, is it safe??

Also, would bruising in mouth definitely indicate kidney disease, I haven't noticed any kidney disease signs, no excessive urination or drinking.  Yes, she'd been miserable and appetite poor last few weeks, but I would put that down to her last dental and possibly more metacam than usual.  Are there any other tests to defintely determine there is a problem with the kidneys?  

Should I suggest she be treated incase of possible stomach ulceration too, if there were any ulcers, do you think that would reduce food intake too?

Thanks for your thoughts,


Sue

Answer
Dear Sue,

You don't say how much your rabbit weighs, nor the concentration of the metacam, but if it's the standard 1.5mg/ml solution, then your bunny must be HUGE to be getting such a large dose.  The standard dose for metacam is 0.1-0.3 mg/kg once per day.  Although metacam is supposed to be a COX-2 inhibitor, it's still not completely safe for the GI tract, and such a high dose would make most vets also prescribe antacids to help prevent damage to the GI tract.

I'm glad your bunny has another vet for a second opinion.  If ulcers are suspected, then sucralfate can be administered to act as a sort of "chemical bandaid" to help cover the ulcerations while they heal.  If the bunny is still on NSAIDs, then I would also ask about adding Famotidine, an excellent antacid to help prevent the ulcers.  But note that sucralfate should be given at least an hour before the famotidine, as it may not work well in a de-acidified environment.

The cheek bruising could also be a result of the high metacam dose, as metacam (like aspirin and ibuprofen) may have some blood-thinning properties.  Once the metacam is stopped or the dosage reduced, this will resolve.  

The best way to assess kidney function is with blood work to check the B.U.N. (blood urea nitrogen), creatinine, and other values.  This can be paired with a test of the urine specific gravity, to be sure that any high blood values are not due simply to dehydration.

Laurabolin is an anabolic steroid, and this drug has been used in cats for renal disease.  I have never heard of it being used in rabbits, so cannot speak to its safety nor its efficacy.

For more information on the molar situation, please see:

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

I don't know any vets who use Hypnorm (fentanyl) on rabbits.  All our rabbit-savvy vets use isoflurane gas anesthetic, even for molar spur filings.  The rabbit is put under, and the molars quickly filed before she wakes up.  I am really not a fan of injectible anesthetics, as these can put a real strain on the liver and kidneys, depending on their mode of breakdown by the body.  Isoflurane (and sevoflurane) are removed almost entirely via the lungs, and have almost no lasting effects.  

The fact that your vets are using injectible anesthetics makes me wonder whether they mostly practice on dogs and cats, and whether you might also need to seek another vet for a *third* opinion.  You can find a rabbit savvy vet here:

www.rabbit.org/vets

I hope this helps.

Dana
For