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GI Stasis in French Lop

22 11:05:24

Question
Hi Dana,
First of all I want to thank you for writing the article "Gastrointestinal Stasis, the Silent Killer". It has given us direction and much needed hope this weekend!!

We have a 4 year old, 14lb French Lop named Chester. He is a house rabbit and very important family member. Chester has progressively been getting sicker (lots of little pellets mixed in with big ones) since about September and has had repeated trips to the vet with no permanent solution. Our vet has experience with smaller rabbits but Chester is the biggest bunny that they see and they have said that he is testing their knowledge in this area.

In January Chester was x-rayed and a large, dried mass of pellets was found in his cecum. He was given fluids and enemas by the vet for the first week. We took him to the vet in the morning and brought him home at night. He seemed to get better and returned to eating and helping me get his veggies out of the fridge. However, the problem kept returning and he would start straining again to poop and dribbling pee. He would end up back to the vet for help.

About 1 month ago his vet thought that the reason he was having trouble pooping was because he had lost motility and that the intestine was stretched due to the large mass that had been there. She taught us how to give him an enema and suggested we give him 50cc's of water, in an enema, once a day to see if we could keep things moving and reduce the size of the intestine.

Chester developed urine burn because he was dribbling pee when he strained. Two weeks ago I asked them to shave his bum because it was always wet and hard to keep clean. They thought he would take care of this himself as the situation improved. However this did not happen. His weight has gone from 14lbs to 10.5lbs.

On Friday, I took him back to the vet and insisted that they shave his bum and check for a mass because he was still straining to poop and dribbling pee. They shaved him and we were able to treat the urine scald with ointment. However, subsequent to that he completely stopped pooping, eating, drinking and urine was only sporadic. They advised us that there was no permanent solution because he could not seem to regain motility himself and that it was time to make a decision regarding euthanasia.

At this point we decided to do more research and to bring him home as we felt the vet had exhausted their knowledge regarding his case. That's when I discovered your article.

Through Saturday and Sunday (February 18 & 19, 2007) we have attempted the following after showing your article to the vet and advising they that we would like to try this before making any decision:

- Simethicone for gas: Pediatric Ovol drops .75 ml, 4 times a day;
- Metacam 1.5 mg: 1 ml, twice a day;
- Cisapride 5 mg: 1.2 mls twice a day;
- Enema: 50 cc's twice a day;
- Critical Care formula

He has steadily improved over the past 2-days, becoming more alert and interested in food. Actually, he is starving and eating loads of veggies (organic herb mixture) and the critical care. His is drinking water like crazy and even came to the fridge this afternoon for more veggies. He won't touch hay yet so we made our own 'critical care formula' (hay, parsley, water and critical care formula liquefied in a blender). He loves this!! We added 1" of banana to one of the feedings and he was in heaven.

So, things seem to be moving in the right direction and late today he spent about 10 minutes eating his cecotrophs (up to now they have not been very edible; very, very bad smelling; and he has not bothered). He is peeing but still not really pooping. He has 1 or 2 pellets but nothing to equal the food he has eaten.

We gave him another enema tonight but now I'm wondering if we are giving too much water in the enema, are we giving too many enemas and how will we know when to stop? Is this the normal course of GI Stasis or is the vet right that he may never be able to fully poop by himself? Where do we go from here?

I'm sorry this is so long, thanks for reading. Any advise that you could provide would be very appreciated. I don't think any of us could bear to lose him. When things are good for him he is a real character and very loving.

Thanks,
Julia


Answer
Dear Julia,

I'm glad my article was some help, but Chester isn't out of the woods until the *reason* for his chronic ileus is discovered.  In addition to the treatments you're giving, please ask the vet about adding lactulose, an indigestible sugar that acts as an osmotic laxative.  This will help hydrate the intestinal contents and get them moving through the intestines.  

It's not unusual to not see poops immediately once the gut starts moving again, and the first ones you see might be goopy and even with a bit of mucus.  But as the intestinal contents hydrate and move, things should normalize.

It concerns me that he was straining to urinate.  Recall from the article that ileus is a *symptom* of a health problem--not the cause. If these vets are familiar with rabbit medicine, they would know that you need to seek the source of pain/stress that's eliciting ileus.  And in light of the urinary episodes, I would certainly ask about checking his urinary tract for problems, which you can read about here:

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

Also, if he's being a picky eater, one of the most common of all reasons for chronic ileus is untreated dental problems, particularly molar spurs:

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

Incorrect diet is another common reason, though it sounds as if this isn't Chester's problem:

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

I would recommend going here:

www.rabbit.org/vets

to find a good rabbit vet in your area for a second opinion.  Chester needs a good "once over" to see *why* he's constantly suffering from GI tract slowdown.

I don't think I'd continue this level of enema much longer, as you *can* overhydrate that way.  The colon absorbs water, and since daily normal intake of water for a mammal is about 90-100mg/kg per day, you don't want to overdo (though it is helping, for the moment).

Ask about the lactulose, and about lessons on how to give him subQ fluids at home to keep his electrolytes in balance while you rehydrate him and get things back in order.

I hope this helps get you started.

Dana