2lb mixed breed....sick??

Question
QUESTION: I have 7 rescued rabbits....well 5 rescues, and 2 that were born to one of the rescues approx. 7 mos ago. They are all small breed, under 3 lbs. I am a "people nurse", and although I have dealt with everything from pasturella so severe the bun was falling over to head tilt and stroke. This one has me baffled and I am hoping you can help. Bun is roughly 8 mos old, and was FINE Tues at 2a.m. (i.e. hopped up to greet me, nose thru the bars...dancing for me for greens, etc. Had her usual 1/2 a carrot, greens, and fresh hay....ate normally, feces were normal. Went to turn off lights and check feed and water last night @ 10p.m (tues) and she was in the corner of her cage she usually defecates in...just sitting. Ears up, eyes alert...no grinding, HR/breathing normal, etc. Ate a little of the carrot, but only when hand fed. Did stand up and stretch a bit...then back to corner. This a.m...seems "tired". Still alert w/no grinding....appearance is similar to when I wake them unexpectedly. HR/breathing still normal, but carrot appears untouched, as does hay. Not sure about water. Nothing overt, but just felt she is failing so called vet. Rabbit savvy vet not in for 2 hrs....next one is 1 1/2 hrs away. ANY IDEA?? Doesn't seem like classic stasis...but does appear there might have been an episode of mushy stool...all other buns are FINE, all had same food from same source. HELP!!

ANSWER: Dear Suzanne,

Your bunnies are lucky to have such a vigilant "mom."  Your bunny is suffering from some type of malady, and is showing very generalized signs.  The stretching could be from abdominal discomfort/gas, so it might not hurt to give her a bit of simethicone and tummy massage to make her feel better until the vet gets in.

Please also see:

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

which explains how to take temperature. This can be very important in a sick bunny, as it tells you whether they may have an infection (higher than normal temp, which also can be affected by stress, but not to fever levels) or shocky (hypothermia), and how to proceed.

I definitely would get her to a good rabbit vet as soon as possible, since the real cause of her lethargy might need some detective work.  I always ask about checking the molars for spurs, since the pain from that can elicit GI slowdown, gas, and even ileus.  But if they're fine, then ask about bloodwork and other diagnostics.

I hope she'll be fine soon.

Dana

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

QUESTION: Hi again...thanks for the quick response. Did get the bunny to the vet. Had another episode of slimy/mucousy stool on the trip over, still urinating well. Still has not had food or water. The bunny is always laying on it's side now, seems to me to be breathing a little faster than normal. Will travel between corner of cage and it's box (where it normally sleeps). Vet palpated, took x-rays, checked teeeth, etc. She said things felt normal to palpation. Teeth had "some small points", but there were no ulcerations, redness, etc....and they did not seem to be anything that would contribute. X-Ray showed (I'll quote) "ground up food in the forward GI, some matter throughout, alot of air and gassy pockets, but no obvious or gross blockage or obstruction, or distention. Bladder is full, but no bladder stones apparent...x-ray would seem to be a normal bunny GI if we didn't know that food was eaten Tuesday a.m., and now it's late Weds afternoon".
Bunny was "treated" to a bath to view genitals, etc (there was brown goop etc. around it's bottom, and back legs were wet)nail cutting, etc....as well as more handling than even I would have done! Showed no increased distress or signs of pain throughout. Temp was a little elevated, but the vet felt the moving, car ride and dogs in the office could have caused this, it was not at fever level.
Dx: maybe a case of stasis that is still at a mangeable point. (she did not seem convinced)
Tx: cisapride .1cc q 12h x 1 wk (weight was 2.5lbs)
also, NO food other than timothy hay and water.
QUESTION: I understand the theory of long stem fiber to get motility going, etc....but wouldn't that be if the bun IS eating and drinking?? If this rabbit has NO intake, solid OR liquid, won't the (potential) blockage further dehydate and become unable to be passed?? Just questions that I did not seem to get answers to today...
Tonight the bunny seems worse to us. Gave the cisapride as ordered, but there are still little piles of mucousy/mushy poop in that corner (they are NOT usual cecatropes...I have seen these for this bunny.) I guess I just feel like I'm doing nothing and it's getting worse. Will fluids via syringe or critical care formula just add to the problem if the food was still in the forward GI? This is a hand fed VERY docile creature who will not even wince at the syringe, and took the cisapride easily and well....so fluids would be okay via syringe. I also have "human" liqid thickener  which we use for dysphagia patients, if that would help prevent aspiration and be safe for a bunny..it's just cellulose.This baby LOVES parsley...would it hurt to offer a leaf or two? Your article seems to say it would be good...
Sorry for the extended question/message....but I TRUST YOU!! I have read all your papers I could at the college website, have been massaging his belly....I just feel HELPLESS!!
Thanks again for any advice you can offer.....
ANSWER: Dear Suzanne,

If the bunny is producing mucus in the stool, then the intestinal lining is inflamed (enteritis), and it's possible that there is a harmful overgrowth of Clostridium bacteria on the rise in the GI tract.  I'm not going to second guess the vet; it sounds as if she's doing all the right diagnostics and treatments.  But I would suggest a few other things to add to the protocol, so you might want to ask the vet about this.

1.  I would absolutely NOT withhold fresh greens.  If this is all the bunny wants to eat, then that's what she should get.  Rabbits seem to be very good at choosing the food items that will make them feel better, and fresh, well-washed, wet greens can only *help* hydrate the intestinal contents.  So let's say I really disagree with anyone who would say to withhold greens.

2.  It sounds as if the bunny has intestinal/abdominal discomfort, if she's stretching in funny ways--and coupled with all the other symptoms.  If she's gassy, then simehticone will help her pass the gas.  The cisapride is also a good drug to use.  But if her intestinal contents are desiccated, they need to be hydrated.  Our vets prescribe lactulose (an indigestible sugar) that acts as an osmotic laxative to draw liquid into the GI tract.  If you use this, it's also wise to administer subQ Lactated Ringer's Solution to be sure the body tissues don't suffer dehydration at the expense of the gut.

3.  If lower GI motility is a problem, we've found that a *very carefully administered, non-aggressive* enema (i.e., no French catheters!  We use only a pediatric ear syringe, and insert the tip no more than about 1/2") can really get things moving, as well as hydrate intestinal masses that are farther down the lower GI tract.  Instructions for enema can be found here:

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

4.  Is bunny on any pain medication.  Truly, in our experience this can mean the difference between life and death.  Banamine is *very* useful for severe abdominal pain, and can be coupled with Tramadol (a synthetic opioid) for excellent pain relief.  Metacam can replace the Banamine, but in my experience it is not quite as powerful a painkiller as Banamine.

Side Note:
If this is a very young bunny (which I'm thinking she might not be), then there is the possibility that she may have an E. coli overgrowth in the intestine, which can be very dangerous.  In baby rabbits and hares whose diarrhea we've cultured, E. coli (heavy growth) has shown up every time, and we have successfully treated it with oral ciprofloxacin.  If this is NOT a baby rabbit, then this scenario is not very likely.  But I thought I'd mention it, just in case.

*****

Hang in there.  With cisapride, subQ fluids, simethicone, gentle massage, lactulose and pain management, she should turn around.  I know it's frustrating watching and not seeing immediate results.  But please do ask the vet about the things I've suggested.  We have found they *really* help.

Good luck!

Dana



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

QUESTION: Dana...
My intuition (research) was correct...mycotoxins in the hay. I INSISTED they see the rabbit again today, it was a different vet who seemed far more "savvy". Re-checked xray & said the cecum was HUGE, and the colon was grossly enlarged...all with gas. (same xray I was told was "relatively normal yesterday..)Palpated and said intestine felt "extremely thickened". Had me palpate as well...ropey knotted MESS. Bunny has lots of gas today as well as some normally formed pellets...but mainly a stinky smeary mess we had to clip at the vet as it was all matted in.
Before I could get the vet to see us, I was desperate, and so took a small bowl and hand ground some parsley and water into a paste. Added about 1/4tsp blackberry jam...I know, sugar...but it was last ditch in hopes it would stimulate eating. Used a 1cc syringe and got about .5cc in before the bunny seemed more interested than stressed. BUT...took 2cc's and then when offered the water bottle TOOK 2oz of water! Hurrah!
OK...back to vet. Does think my "assessment" (won't say dx...lol) was correct, mycotoxin toxicity.
Tx today consisted of:
~in house Coccidia culture of stool (neg)
~2nd culture sent out for accuracy
~teeth and mouth re-checked
~ruled out "string foreign body"
~SubQ ringers, given bolus. (after 3 sticks...)
~stop Cisapride (I already had)
~add fresh dark green leafies back (already had)
~Oxbow Critical Care (2tsp mix~3tsp h2o 4~6x qD w/syringe)
~Baytril banana .5cc b.i.d.
~.05cc buprenex SQ in the office, and after watching  me draw it and inject she sent me home with a bag of syinges, needles to change to to inject, and buprenex, to be given q6-8H prn for pain.
~advised a bottle w/ 1/2 gatorade, 1/2 water in addition to the regular water bottle.
~told me to palpate what I had felt q12h, and if there was NO change AT ALL in what it felt like in 24h, to call back.

Tonight I am happy to say (guardedly) the bun does look a LITTLE better. Eyes are less "sticky" looking, turgor at back of head is better...more alert,cleaning face and ears again, etc. Had another dose of pain med...but the crtical care is a challenge. HATES it and squirms and runs. I may try your recipe tomorrow as feedings seem to cause more stress than the injections, baytril, and massage.
Nibbled at some fresh hay, but I think more to get it out of the way to lay down...but did again drink a few oz of water without any assist.
This is far more frustrating than being a "people nurse"...closer to when my son had colic!!
Thought I would update you, and thank you for giving me the "tools" to sound like the forceful, educated , pet owner I went back as today! It truly may have been the difference between life and death for this 2.4lb baby!
I'll keep you posted....
oh, P.S...bun is 7~8 mos old

Answer
Dear Suzanne,

This *could* be mycotoxins, but there's no good way to know for sure without testing the food.  T4 mycotoxins (the most common) will not grow in grasses, but rather are parasites in alfalfa and other legume hays.  The fungus produces T4 toxins only when the environmental temperature reaches a particular low, so if the hay you're feeding is alfalfa that was harvested in the winter, this *could* be a possibility.

But the main thing is to get bun well for now.  And the one very important item on the "menu" above that I see missing is Questran.  This will adsorb toxins from the intestine and prevent any further damage.  It can *really* help.

Also, lactulose can help osmotically remove toxins from the bloodstream if the liver has taken a hit (which is likely, if this is truly a mycotoxin issue), so this would be a relatively harmless addition that could help.  Please ask the vet

I'm sending lots of healing vibes!

Dana