Rabbit stopped eating and died

Question
QUESTION: He there,
You helped me out the last time I had a question about my sick rabbit and I was very grateful.  I have a question concerning my rabbit that just passed away this morning.
Amber, my 3 year old dwarf rabbit stopped eating her favorite food 2 days ago and I noticed she did'nt want to come out of her house to greet me as she always does. I waited a few hours to see if maybe she would perk up but she did'nt. Knowing that when rabbits don't eat they need to be seen by a vet, I took her straight there. My vet is so cluless it's frustrating. I knew more than they did but I knew I could get a broad spectrum antibiotic from them for her. They gave me some critical care mixure to feed her and a rabbit antibiotic. They also gave her a fluid bump. I hand fed her the mixture, plus a probiotic and she was drinking some water the rest of the water I gave her in a dropper. She wasn't pooping and her urine smelled very, very (took my breath away) strong. I have never smelled it that strong before. The next day she started to grind her teeth when I feed her thru the syringe, she also grinded her teeth (very loudly) when she drank water. This freaked me out because I have never heard this before. I tried baby mylanta because I thought it was what the doctor said- GI Stasis. I also massaged her belly. Last night she had a hard time lifting her head and started to wobble a little when she tried to walk. I forgot to mention that she stayed in the same position all day on her belly with her hind quarters sort of lifted (on her back toes). She did not like to move. SHe was urinating a little. I thought because of this position it could be a urinary tract infection or bladder stones. She has a very good diet except for the fact that I ran out of hay and my local pet store did not have the hay I needed. My rabbits went without hay for 5 days, they still had pellets, lettuce, and always plenty of water. I get so frustrated not knowing what could be wrong with rabbits!! I have had three die on me in my lifetime and each one I spent over $1,000 each to try to save them. It seems that no one really knows how to treat these fragile creatures and they go down hill so fast. I was planning on taking my rabbit to a special exotic hospital 2 hours away this afternoon for xrays , but she passed away during the night. I woke up and cried my eyes out. I am a bunny lover and it kills me that I don't know what went wrong. Please, if you can I would love to know what you think could have been wrong given the symtoms.
When I found her in her house and I examined her she had some fecal pellets halfway out of her rectum. They were regular size and It looked like she might have died while defecating.
Her symtoms were...
-Stopped eating 24 ours
-Strong urine smell -slight pink tinge the day before she died
-trouble moving -did not want to move
-Swollen abdomen
-no fecal pellets until death
-teeth grinding from pain
-Lying in the same position all day
I think it could be either...
Bladder stones. Urinary Tract infection, GI Stasis or a blockage (but she did poop after she died).
She is an indoor only rabbit with a very clean enviroment!
I would love to know what you think and if she could have been saved by any medical procedures.
Thank you so much for taking the time to read this and I look forward to hearing from you.
ALL the best,
Kristin B
New Jersey

ANSWER: Hi Kristen,

I am very sorry for your loss.  I would have cried too.  I understand how much you love your pets.

Two things strike me as being big problems.  The hay not being around for five days started the problem and I believe led to her gi stasis.  Hay is THE thing that makes up 90% of the mass of their regular fecal poops.  It is the most critical thing they need, more than anything else.  If you can't feed them lettuce, pellets, treats - if they have hay, they don't need anything else, they will survive.  It is what they are designed to eat.  Take that away and gi problems begin.  She probably wound up getting gas buildup in her cecum and this lef to her not wanting to eat or move, and because of this, gi stasis began to set in.

The second thing that contributed to her demise is the poor vet care you received (just my opinion, I am not a vet).  This was not an infection, based on her symptoms and the fact she had no hay for 5 days.  They needed to pump sub-q fluids, give her a motility drug to get her out of gi stasis, and give her pain meds so that she would get an appetite back and feel able to eat again and move around.  The teeth crunching you describe is a clear textbook symptom of a rabbit in pain, and the vet didn't pick up on it.

Now you ask if she could be saved by proper medical procedures.  The answer is yes, if she was not too far gone when you brought her in.

While the advice I will offer to you won't help your girl now, grieve properly for her but don't let it drag you down forever.  The fact is this was accidental.  You tried to do what you thought was okay for her until you got hay again.  It was just unfortunate the vet you went to is not a good rabbit vet.  But I think as her owner you did the things you thought best for her.  Don't beat yourself up for it too badly.

Here is my advice for you for your rabbits you have now and in the future.

1.  At the first sign they are sitting funny, not moving normal, and/or not interested in food like they normally are, THIS is the key sign there is a problem starting or already started.

2.  when you see this sign, you need to act quickly to prevent it from becoming something you need to get to the vet for.  Most often they have trapped gas in their stomach or cecum or intestines.  You need to pick up a couple bottles of simethicone (baby gas drops) - get Gerber brand as it is banana-flavored - and give your bunny 2-3 full plastic dropper doses.  Then with a pillow on your lap, hold your bunny so that you raise her front off the pillow, and get your other hand around her and underneath to massage her belly - you can go up and down, and also light circular squeezing.  Do this for 1/2 hour to work the simethicone through the stomach and into the cecum.  The massaging itself often makes them feel better and may also help to break up the gas bubbles.  you may hear your bunny teeth grind (with pleasure) as you are doing this.

Repeat this whole thing above 1-2 more times as needed.  If it is gas, you should start to see them feeling better and acting a little more normal and want to move a bit.

3.  If they have a gas attack, the next few days stop feeding everything except hay and pellets.  Greens and fruit and that are not good at this point.  Slowly add greens and such as you see them get back to normal.  You may want to reduce their portions to a new lower level, as this could have been an indication they were getting too much greens and such and it was throwing off their gut bacteria.

If this works, you should give your bunny a dose of the simethicone once a day for the next few days - you can even spread it over their pellets.  This is just a precaution.  You also need to give them probiotics like acidophilus - even some Bene-Bac from your local pet supply store.  You can get acidophilus tablets that are banana flavored on the web (I can't remember where, but google will find them for you).  I would give them one a day for the next few days to build up good bacteria in their system.

If your rabbit has been like this for more than 1/2 a day, you have an emergency and should immediately go to the vet or an emergency vet at that point.  Call ahead and let them know you are bringing in a bunny in gi stasis so they can prepare for you.

4.  Never run out of hay.  Always have more than you need.  They can live without everything else (save water).  They can't without hay.  this was a hard way to learn the critical importance of hay to rabbits.

5.  Find a good rabbit vet.  A good rabbit vet is critical when you bring in a sick, injured or dying rabbit.  I can't remember if I mentioned this but go to:

www.rabbit.org/vets/vets.html

and find a House Rabbit Society-recommended vet in your area.  If none are listed, check neighboring states if you are close to a border with another state, or call up local animal shelters and local/state rabbit rescue groups and ask them where they would go with a sick/injured rabbit.

Again, I am very, very sorry for you and your bunny.  It is frustrating and heartbreaking when you feel you don't know what to do, or that the vet doesn't either.  And if you are a fellow Christian you will be able to see your pets again and it will be wonderful because neither of you will ever be sick again or die again.  For now you can still remember her in your heart.  

Write back anytime.

Lee

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

QUESTION: Lee,
I can't thank you enough for getting back to me so quickly and for your kind and reassuring words.
I am amazed at how fast she went down hill. I did do the baby gas drops and the massage about 12 hours after I first noticed her being sick. I googled every possible sickness on rabbits and read about that medicine. I think she was too far gone by that point. It kills me that a simple thing like no hay could have caused this. I want to call the vet up and yell at them because they should have caught this. I took her straight to the vet 2 hours after I noticed she hadn't touched her food. However, she was not grinding her teeth in pain until the next day so I never told the vet that. She just told me to force feed her hay in liquid form and give her the antibiotic. The only hospital that takes rabbits is two hours away from me and the last rabbit( a rescue)I brought there died from the shock of being handled too much. $1,200 later they handed me my rabbit in a box and gave me a sympathy card. I cried for 2 weeks. I promised myself and my three rabbits at home that I would try to do whatever it took to avoid them being at that hospital. I tried everything I read for GI- Statis. The vet should have done what you suggested and I am furious they did not. I know if I had a better vet she would  be alive. I do feel good that I loved her and held her up until she breathed her last breath. She died at home in her little hut with her family. I am a fellow Christian and I did pray over her last night. I knew by the look in her eyes that she wasn't going to make it so I asked God if he was going to take her to take her peacefully. When I woke up she looked like she was sleeping on her side in peace. I know he had answered my prayers. I can't help but feel extreme guilt over the fact that I contributed to her death. In time I will try to get past this. I will use the knowledge you gave me for my remaining rabbits and not let her death be in vain. Thank you for being so kind and your words so healing.
Being able to talk to you (type) is so healing.
Thank you with all my heart.
Your sister in Christ,
Kristin B

Answer
Hi Kristen,

thanks for your kind reply.  I am glad you tried the gas drops, it further shows you were trying to do what you could when you noticed the problem.  You are right, it is very sad that lack of hay for a period of time can really cause problems for our pets.  Nothing else can really take its place as far as pellets, lettuce, etc.  In an emergency you could always take long grasses that are unmowed and rinse them off (insects, parasites) and give them to her, but it would not be my first recommendation.  

If you have ever seen hay cubes (Kaytee and others make these) in 1-pound bags, even this would have been better than nothing.  It isn't long fiber hay, but it is actual hay that has been compressed into cubes.  They are small enough to keep around in the fridge (freshness) and have on hand in emergency.

You will eventually be able to take comfort in the fact you will see your little gal again.  She already knows it wasn't anything deliberate or mean on your part.  You were there with her, trying to help and do what you could.  Look at it this way, if you can look in the mirror and say that you did the best you could at the time with what you knew then, then don't hold it against yourself.  Cry about it, cry for your loss, but at the same time be glad she's okay now, you had time here with her to love her, and the next time you see her she will be in perfect health and the two of you (and your other bunnies) will be able to live together without sickness or pain, forever.

The positive is what you have learned from this.  It will be helpful to you for your other rabbits.  You will be able to give them better care as a result.  And hopefully you can find a better vet near you.  The other thing is that you are in a better position now to prevent this from happening again.

As far as rabbit nutrition goes, think of a pyramid divided into four sections.  The base foundation section (largest) is hay.  Unlimited amounts, all the time.  It is the only thing they need to survive.  Everything above it is optional (ie they can live without).  Hay has the least calories, they will never get fat on timothy hay or orchard grass hay.  Also, everything else above hay has limited quantities, otherwise you run the risk of diarrhea, gut problems, or obesity and such.  As you go higher up the pyramid, the amount to give them  decreases, and the number of calories increases.  

You can count hay cubes in this first level, as it is hay.  It does not replace regular hay because it is not long fiber hay, so don't view it as a replacement for real long hay.  In an emergency it will temporarily fill the gap until regular hay can be given.

The second section above hay is greens.  No more than 1/2 cup per 5 pounds body weight per day (none if they are having gi tract problems).  I limit the variety of greens between 2-3 different types (that combined are 1/2 cup
total or less).  Be careful as not every known 'safe' green is tolerated well by every rabbit.  The main thing with greens is that they can cause diarrhea and/or gas problems.  Cilantro and kale for example are prone to cause gas, so I avoid them outright.  Their regular greens, if fed too much (even with hay) can cause gas buildup.  This Friday night I had to do simethicone/massage on one of my rabbits who had mild gas.  If this happens cut the greens out for a few days to a week, then reintroduce slowly the normal greens, one at a time, give each a week.  Maybe one of these is not being tolerated by them as well as the others.

The third section is pellets.  No more than 1/8-1/4 cup per 5 pounds body weight per day, max.  The main issue with pellets is that too much can cause obesity.  If your rabbits are prone to be overweight or are not as active, they should receive less pellets.  No junk in the pellets, just pellets, like an Oxbow Bunny Basics T timothy hay pellet.

Fourth and top section is treats (fruit pieces, carrots, banana, pinch of oats, etc).  Less of these as the high sugar items will throw off gut bacteria and cause problems and gas, and obesity.  A few pieces of dried papaya (or a papaya tablet), a couple 1/8" slices of carrot, one 1/8" of banana (I don't recommend as it's bad for their teeth), a small pinch of Quaker oats (not the instant kind, the regular kind), 1-2 cheerios.  Per day.  Cut down on them greatly if overweight, do not give any if they are having gut problems.

You can also give petromalt (a quarter inch (small) round dab on a finger or on top of pellets a day can be a preventative for hair blockages.  Some people only do it when shedding is going on, I tend to do it all the time because their gut is used to it and it doesn't hurt them to have it everyday.  I feel they are more used to it and their gut is used to having a small amount everyday.

The other key to rabbit diet is consistency.  They cannot handle huge changes in diet in short periods of time well, because of how their gi tract works.  It is not good to outright stop giving them things if their gut is working normally (the exception is when they are having problems, as noted above) because this very act can throw off their gut balance and create a problem.  If you are going to add or remove something from their diet, you need to do it gradually so that their gut bacteria (in the cecum, mainly) can slowly adjust to the change and handle it over a period of 1-2 weeks, more time being better) than all at once.  It is a shock to their system to all of a sudden get a large (relatively speaking) amount of something new, or stop having something their gut is used to.  It can throw their bacteria out of balance and that's when gas and other problems can start.  So consistency is key.  If you are not sure you can always give them the same greens, you may not want to give them a particular one, or if they are seasonal, plan ahead and ramp them up over two weeks when starting one, and ramp them down two weeks before you can't get one anymore.  Hay doesn't fall into this category because hay should always be around.  Plus quantity is not an issue either as most of their diet will be hay anyway.

When they do have gut problems, hay, hay cubes, and timothy hay pellets are what they should be on along with water.  Plus acidophilus and maybe Bene-Bac supplements.  Simethicone for gas treatment if there is signs of pain/not sitting right/not moving/not eating.  their gi tract system needs a 'reset' and hay products and water are what gets them back to good condition.  Everything else is bells and whistles.

I'll pray for you and your little gal.  You'll heal from this.  Just think though, wouldn't it be even sadder if you weren't affected so much by this, if you didn't feel that bad about it, or were indifferent to it?  That would be a real tradgedy.  No, it's good to work through it because you have real loss, and you truly did love her, and this is what we go through when experience loss of things we love.  God uses our pets to teach us things.  To be more caring.  To rely on Him in instances we are clueless and powerless.  So many others.

If you feel you need to ask Him forgiveness, ask.  If you need assurance, talk to your pastor about it.  He should be able to offer you assurance of God's forgiveness.  Forgive yourself if you feel you have to.  This doesn't mean you stop grieving, but as a part of your grieving process.  It may not happen all at once, that you actually feel it.  But don't let it drag you down.  You know where you can put your burden.

Spend some time looking for a better vet. I think it will be a worthwhile effort to do.  Call up your local or state HRS groups and see if they know of any good vets around you.  If they don't they may be able to point you to other groups or people around your area that may know someone.  Or get in touch with the shelters and see if anyone has any leads if they know any vets with solid experience with rabbits.

God bless you and your rabbits.

Lee