Urinary tract infection

Question
QUESTION: Hi, I have a house rabbit who keeps getting water infections, (thats what we assume is the cause of the wetness/stinkiness) she has had several now.  She is two years old, at first (after the first few infections) the vet thought it could be hormonal as they were quite regular so we had her spayed in January, while she was knocked out she had her teeth done (the vet said there were only a few minor spurs) she also had some urine taken and sent off for tests, the results were that she did have quite a few crystals in her urine but vets didn't seem concerned about that, before she was spayed one of the vets thought it could be some parasite and prescribed Panacur, after one dose of this she stopped eating/drinking and we had to rush her back to vets (saw a different one) the water tests later showed she didn't have these parasites.  Saw same vet 2 weeks ago, again he was on about these parasites/worms and wanted to prescribe Panacur again (we told him we weren't happy about that after what happened last time and also cos tests showed negative (sure he is on commission), he then prescribed 0.2ml twice a day of Baytrill, nothing happened, took her back, saw different vet, told us that dose was too small and she prescribed 0.5ml twice a day, but still showing no signs of clearing (I know it is only 2 days on higher dose but other times she was starting to dry up after two doses), bit worried that she is getting used to anti-biotics, she is drinking more, wondered if you had any other ideas as to what could be causing this wetness, her cage is kept clean and she also is out of the cage for several hours a day with her just popping back in to get some food/water and to go to the toilet
ANSWER: Dear Valerie,

Have any radiographs been done to check for bladder stones?  These can cause dribbling/incontinence, as can bladder sludge.  If the urine is very clear, she may be retaining calcium salts crystals in her bladder, which can cause leakage and also promote bacterial infection.

Has a culture and sensitivity test been done on a clean urine sample?  Please read:

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

for an explanation of why this is important.

The parasite your vet suspects is a very dangerous one known as Encephalitozoon cuniculi.  I'm not familiar with it causing unusual odor of the urine, but if your vet does suspect that, the most common diagnostic tool used to assess this is a paired blood titer.  A blood test also can be used to assess her overall renal function.  If she is drinking excessively, she may have a kidney problem (an infection?) that could be causing this odor.

All that said, it does sound as if your vet knows a lot about rabbits, and has done some good diagnostics.  If you could ask about anything above that has not been done, it might just give a few additional ideas.

The other question:  Is her urine stinky immediately upon her voiding it, or does it develop a smell only in the litterbox?  If the latter, then a change of litter material might be in order, as many litters don't absorb odor well, allowing the pee to deteriorate into bad stinkiness!

I would recommend Feline Pine or other pelleted sawdust litter, as this will completely eliminate litterbox odors.

I hope this helps with some new ideas.

Take care,

Dana

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

QUESTION: Thank you for your answer, We are taking the rabbit for x-rays on friday, her cage isn't really smelly it is more her, around her bottom, she is soaked and she smells of wet stale nappies, when I picked her up yesterday to wash her bottom she did started doing a wee and it was white, don't know whether that is good or whether that is calcium in her water, when she had her water tested in january, it did come back that she had a lot of crystals but vet doesn't seem too concerned, said that is quite normal in rabbits
ANSWER: Dear Valerie,

oooooh.  Poor bunny!  For her to pee when you picked her up and have a lot of white crystals is very typical of a rabbit with a bladder full of sludge.  This may take a while to clear up, unless the vet thinks it would be wise to do a bladder flush.  We have done this, but to tell you the truth we've found it to be even more productive to have a short course of subQ fluid therapy accompanied by manual expression of the bladder.

With a sludge bunny, we administer fluids, wait about 45 minutes, and then gently jiggle the bladder to suspend the sludge crystals in the urine.  Gentle expression of the bladder (your vet can show you how to safely do this--you must never force anything!) will help her void the crystals.  Over the course of a few days, the bladder should come clear.

But unfortunately, sludgy bladder is a sign of metabolic disease, and it is not likely to resolve.  Reducing calcium in the diet will not usually be effective, and some very experienced vets actually think this can do more harm than good, since the bunny already is having trouble with calcium metabolism.  Rabbits with lots of bladder sludge tend to have--unexpectedly!--relatively *low* blood calcium levels, as they seem to have trouble keeping it in the system.  Rather, it's just constantly peed out, and it does build up in the bladder.

We have a couple of sludge bunnies, and we just do a constant vigil on their pee, and express their bladders regularly to help them void the crystals.  Jiggling the bladder first to suspend the stuff is a vital step.

I hope some of this helps, or at least gives you some ideas about what to ask the vet.

I hope she's well and feeling fit soon!

Take care,
Dana

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

QUESTION: Just thought I would let you know, I have just picked Schumi up from having her x-rays, she did have bunny sludge, in fact her bladder had so much calcium in it actually showed up denser than her bones, the vets have given her a bladder wash so hopefully this will help.  Thank you for all your help over this and past questions I have asked you.
ANSWER: Dear Valerie,

I'm glad she's gotten a flush and will be feeling better.  This could be a chronic problem, since metabolic bone disease doesn't resolve on its own, and may always be with her.  So keep a sharp eye, and you'll be able to catch this before she gets stinky.

Good luck, and Happy Mother's Day (even if your only child is a rabbit)  :)

Dana

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

QUESTION: Hello, Sorry to bother you again but I was wondering if you had any ideas on why schumi has died, she was only 2. As I said earlier, she had a bladder flush on 11th May, unfortunately she died yesterday, I realize it isn't possible to get an exact cause of death without a post-mortem but any thoughts would be greatly appreciated. Even though she had her bladder flushed out, it was only two days later when she started to get a soggy bottom again, a few times when I washed her she was still passing chalky wee, especially a couple of days before she died. On Tuesday she wasn't herself, she seemed to be going into corners and staring, that morning she was actually inside her castle in her cage, she hasn't been in there for about 18 months as she likes to sleep on top of it, also she wasn't eating or drinking, I was mixing oxbow bunny basics/t with water and giving her this through a syringe, anyway I took her to the vets, she did do a wee on the table which was actually clear liquid, the vet tested it and said that there was some blood and protein in it which could indicate another water infection, he gave her an anti-inflammatory injection and sent me home with baytrill, a couple of hours later she seemed to have "ants in her pants", she couldn't settle she was racing from one spot to another, even when she was put back in her cage, bumping into things as she ran and her heart seemed to be racing (could the injection have done this) she was still clattering around her cage at midnight so I picked her up and had her on my knee on a towel (she loved strokes but hated to be picked up so this was very unusual). I could feel my eyes kept going so about am I laid on the settee with her in case I nodded off and dropped her, she just laid in my arms, she wriggled a bit about am so I put her back in her cage as I put her in she had a bit of a jerk (a bit like a fit) then her back legs seemed to go weird, pulling really forward then she went on her side and died. There was loads of crumbs and small pieces of chalky stuff that dropped off the towel which had obviously dried after she had a wee, how could she have had so much calcium in her after only having a bladder wash 11 days earlier and if she had that much calcium in her, then how come the wee she had in the vets was clear. Also on Monday, we put her out in her new run, she wasn't used to being outside but had been out a couple of times previous to this, could this of killed her? Thank you for all you help in schumis short life. Valerie Hall

Answer
Dear Valerie,

Oh, NO.  This is such a terrible shock!  I am so very sorry about this horrible turn of events.

I wish I could tell you why she died, but as you say, only a post mortem exam would really reveal anything.  And in a case like this, I would recommend that you have this done by a vet who was NOT caring for her at the time (i.e., the one who did not do the bladder flush), in case the cause of death was somehow related to the bladder flush itself, or to the handling she received during the procedure.

It is very possible that you could not have saved her, and that she had something serious such as a kidney infection going on.  As I mentioned, we usually try to do manual expression and subQ fluids before we resort to a bladder flush, simply because things *can* go wrong with a flush, even if only rarely.

Blood in the urine could indicate damage to the kidneys, perhaps even a puncture or rupture of the bladder itself.  This might *not* be from veterinary negligence or mishandling, but only because Schumi's condition was already so precarious that the procedure--even done properly--pushed things over the edge.

I hope this was not the cause of Schumi's death, but without a post mortem done by a disinterested party, there may not be a way to know for sure.

I am so very sorry about this tragedy, and the short life Schumi had.  I am glad she had you to care for her, and that was a great gift for her, even if her life was too short.

Take care,

Dana