URGENT-(possibly) compacted food in stomach!

Question
Hello again, Dr, Krempels.

After further thought on your reply, I have some concerns and questions:

1.) You mentioned you weren't totally convinced Digger's problems were from overeating. If not, I would be interested to know what could cause these same symptoms so I could keep an eye open for other problems I might otherwise overlook.
2.) His appetite yesterday and this morning is amazing! However, I'm concerned of why he's so hungry all of a sudden. Also, although he is pooping, it's not a lot. I was expecting to wake up and see a lot more poop (only 20 pellets through the night) considering how much he ate yesterday. In regards to how much and what he ate yesterday, he ate Romaine lettuce (2 c.), cilantro (about 2c.), a few basil leaves, and 2 reg-sized carrots grated. This is his usual amount of food minus a few more carrots. I saturate all of his veggies by spraying water on it right before he eats. So, again, my concern is how much is too much when it comes to him eating these veggies considering his condition (I'm worried about a distended stomach). And, is his sudden increase in appetite a good sign? (This morning, he was waiting by his food dish for his morning buffet and wasted no time consuming 1c of romaine lettuce and an hour later, 1c of cilantro and a few basil leaves! Normally he spreads this over a 4 hour period of time.) And as I'm typing this, he's still waiting by his food dish for more food!

3.) His weight is about 7 lbs, 6 ounces. (In the good ole days, he used to weigh almost 9 lbs.) When I brought him in on the third vet visit, he had lost 5 ounces within 3 days. This was when his appetite was very sluggish and feel I shouldn't be too alarmed or should I? How long will it take him to gain some weight?

Digger seems to be doing and feeling fairly well. He's hopping around visiting all of his favorite spots; he's still grooming himself; and he still runs up to visit with me and demands grooming :D I'm hoping what he's showing me on the outside is an indication of how things are going on inside, but I'm not prepared to put my guard down just yet.

I'm waiting on a callback from my vet this morning and will offer these same questions as well. The more information, the better!

Thank you again for your generosity of time!
Wanda and Digger



Good news is his poo pellets are starting to look normal. He is
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The text above is a follow-up to ...

-----Question-----
Good morning, Dr. Krempels.

Digger, my 9 year-old White New Zealand, gorged himself on rabbit pellet food I had very stupidly left on the floor (he's free-roaming in a safe area) in the middle of the night 3 days ago. He hasn't drank from a water bottle in months, maybe even a year, at the onset of me generously supplying fresh vegetables. Therefore, after consuming so much dry food, he was unable to eat in fresh veggies to get any hydration in his stomach.

That evening, before I realized what the problem was, I brought him into the vet due to his very sick appearance and lack of poo pellets and urination. After drawing the conclusion that he indeed overate (I saw him helping himself to the bag when I woke up that morning), the vet administered subQ fluids and gave me some Lixotinic to give him as well to help stimulate his appetite in order to get the water from his only source-veggies. We were hoping teh hydration would help teh digestive process.

There was no improvement at all, so I brought him in again in the morning and they gave him subQ fluids again. After giving him an enema, they gave him an xray which revealed a (possibly)compacted stomach (absolutely white on xray). This time, they kept him for the day to monitor the progress of the enema and to syringe feed him some pineapple. I was excited to hear that he even ate some fresh basil I brought for him. They were pleased with the improvement and I brought him home.

His appetite did improve some, but the poo pellets just weren't coming and his urination stopped again (dehydration). So, this being the third day, I brought him in again, if anything to get subQ fluids. They took another xray and the only difference in the xrays was that the latter showed some very tiny dark specks throughout the stomach, but it was still completely full. The vet gave him a dose of Cat Lax (1 inch from tube) and prescribed for me to give him an 1/2 inch 2x/day at least for today. His theory is to help pass the noncompacted food through his system.

I have also given Digger Kyodophilus daily (mixed with water and give through a syringe) since the onset of this problem (another vet said Kyodophilus is good for rabbits).

MY QUESTION IS THIS: what food or supplement can I give him that will both help dissolve this rabbit pellet food in his stomach and not upset his stomach? And, do you agree with giving him the Cat Lax?

I have read your article and I want you to know that everything I have done up to this point was a result from reading it-THANK YOU! I even printed it for one of the new vets who has admitted to me that he was not too knowledge savvy with rabbits and researched with the other experienced vets and vet resources before doing anything with Digger (I really appreciated that)! He really appreciated your article! So, Please find some comfort in knowing that all of Digger's success thus far has to be credited to you and to your beloved Alex.

I do want to get him some papaya powder (like you mentioned), but I don't know, if in the event it stays in his stomach awhile, it may upset it and make matters worse.

Anxiously awaiting your reply,
Wanda and Digger


-----Answer-----
Dear Wanda,

If this problem is, indeed, from his overeating pellets (I'm not actually convinced of this, but it's not impossible), then the ONLY thing to do is to give him constant, small doses of oral hydration.  Just water in a syringe to make sure the pelleted food becomes well hydrated and starts to pass through the sphincter of his stomach.

Personally, I would not use Cat Lax if the food mass is truly dehydrated, as it might coat the bolus of food and prevent its hydration.  It might also help to administer pediatric simethicone suspension, in case the dark spots in his stomach are gas bubbles forming because the food is starting to ferment.

Hydration of the food mass can also be facilitated by oral administration of lactulose, an indigestible sugar that acts as an osmotic laxative.  I'm not sure it works as much in the stomach as in the lower GI, where more water transport takes place, but it can't hurt and might help.  We use it at a rate of 0.5 cc per kg once or twice per day, but making *sure* the bunny is well hydrated with both subQ and oral fluids.

It sounds as if your vet has very good instincts, even if he's not as familiar with rabbits as he wishes.  SubQ fluids and oral hydration are key.  

It's actually not unusual for a rabbit to have a stomach that's radio-opaque; the rabbit stomach should never be empty, although it should not be distended beyond normal size.  Hydration, hydration, hydration will help this pass through.  Did I mention hydration?

Does he have normal lower GI sounds?  If he is in ileus, then the intestines will be very quiet.  I am not sure I'd give intestinal motility drugs if there's a possibility his stomach is overloaded.  But it will help if you can get him to lie on his LEFT side, and gently apply an electric vibrating massager to his stomach, once he's had some oral fluids.  Don't push too much oral fluid, since you don't want the fluff to overexpand too quickly.  

The rabbit pylorus takes a rather sharp turn just caudal to the stomach, and if the stomach is highly distended, this can actually pinch off and cause an acute bloat, which is usually fatal.  If this hasn't happened yet, it's not all that likely to happen.  But lying him on his left side and doing gentle massage can help loosen things up and help them pass.  

I hope this helps get you started.  Please let me know how he does, if you have time!

Dana

Answer
Dear Wanda,

Taking your questions one at a time...

<You mentioned you weren't totally convinced Digger's problems were from overeating. If not, I would be interested to know what could cause these same symptoms so I could keep an eye open for other problems I might otherwise overlook.>

There are *many* possible reasons for the "general malaise" your bunny sounds as if he suffered.  An acute gas attack can do this, as can more chronic conditions.  You don't mention just how much pelleted food he ate, but I've never known a rabbit who ate so much that he did himself damage--unless it's not rabbit food (I do know of a rabbit who died from eating 2/3 a family sized bag of Doritos; it was probably due to salt toxicity).

These might help:

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

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

<So, again, my concern is how much is too much when it comes to him eating these veggies considering his condition (I'm worried about a distended stomach). And, is his sudden increase in appetite a good sign?>

His increase in appetite is the best possible sign.  A rabbit who has a good appetite is not feeling sick.  Again, I've never known of a rabbit who could eat enough fresh leafy greens or hay to make himself sick.  Pelleted food could be another matter--but I've never heard of that, either.  Rabbits generally know when to quit, though slight overeating over time can cause obesity.

<His weight is about 7 lbs, 6 ounces. (In the good ole days, he used to weigh almost 9 lbs.) When I brought him in on the third vet visit, he had lost 5 ounces within 3 days. This was when his appetite was very sluggish and feel I shouldn't be too alarmed or should I? How long will it take him to gain some weight?>

Very sudden weight loss like this is usually due to dehydration.  Once he's well hydrated again, the weight should appear very quickly.

If he is showing signs of chronic, slow weight loss, then it would be a good idea to have bloodwork done to check his overall health.  At his age, he may need a checkup just to get some baseline values so you'll know if something goes wrong.

But if he's acting well again, and has a good appetite, the poops should follow shortly.  Just be SURE he's well hydrated so that the works don't gum up again.

Hope that helps.

Dana