Pain Meds

Question
Hi Dana,

I was actually working with three different doctors here. So I'll explain in more detail. On Thursday, Oct 14 she was spayed by what I consider an excellent doctor who has spayed and neutered seven of my rabbits before without any problem. She spays and neuters rescue rabbits too and has done so for years, so I'm feeling confident with her. She was the first vet.

For the first five days post-op, my rabbit seemed fine. Active, eating normally and pooping like crazy. However, on the fifth night, October 18 she went into rapid breathing and laying very uncomfortalby in her cage. I rushed her to an emergency clinic where a second vet, who specializes in exotics and has done many spays himself, took x-rays and identified the stomach mass pressing on her lungs. This vet said it could have been an underlying problem before surgery, a pasturella problem gone wild from stress, or a post-op condition. He really couldn't tell what the cause was.  

The very next morning she died in her cage. I took her to a third doctor at my job (a feline only vet practice) where a vet friend of mine did the necropsy. She identified the mass, toxicity and decaying tissue. In her "less than saavy lagomorph opinion" (since she's a feline doctor), she believed the rabbit's system shut down from the stress of the spay and this mass of gunk built up in her system. As if her body was just too weak to recover, and she was a bad candidate for any type of surgery. Although her organs were all identified in great condition during the necropsy.

Because my rabbit was fine after the Sx, eating and pooping like normal, I don't understand how her system ever "shut down". To me, she never had stasis at all. In speaking with a fourth exotic vet, he said that a rabbit can become toxic and such a mass can build up in a matter of days. I really don't understand what happened. The original vet who performed the spay did a pre-op exam with me in the room and everything checked out fine. Upon notifying her of my rabbit's death, she had no explanation of why this happened.

So I don't know at what point things went haywire and why. She was the cutest little, spunkiest dwarf named Short Stop. A real spit-fire, full of personality. We loved each other so much. I wish I never had the operation done, but I felt it was the right thing to do. If I only knew the outcome ahead of time....

Actually, one more observation...when the emergency vet looked at the x-ray he saw a single suture placed an inch or two above the actual spay site. It looked unusual so he asked me if the original vet mentioned anything to me about repairing a hernia during the spay. I said no, that nothing was mentioned. God forbid, could this have been a suture holding together a breached intestine? I'll just die if this was all the vet's fault.      

Thank you so much for any input.     

Amber
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Followup To
Question -
Hi Dana,

To follow up with your question, I'd like to give you more info about my rabbit's blockage.  3 nights after her spay, she began breathing very very rapidly and was so uncomfortable that she kept laying in wierd positions all over her cage. Emergency x-rays showed a huge mass in her stomach which was pressing on her lungs, making it very hard for her to breathe. Her intestines were o.k. except for some notable gas. Maybe the vet declined Torbugesic due to her respiratory problem. He suggested and ultrasound as soon as possible to determine what the mass was. He believed it was some kind of soft tissue.

Early the next morning I found her dead in her cage. I had a necropsy done and the vet found a mass of rotting food, mucus and liquid which had completely distended her stomach and her entire system was toxic. Even the fatty tissue around her spay site was in decay. The vet says she probably died from a heart attack due to her toxicity. This doctor believed the stress from the spay made her system close down and brought her to this state. It all happened in just a matter of 3 days, so I was completely devastated. So, pain meds don't help with blockages? I'd like to know for next time.

Thank you,
Amber

 
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Followup To
Question -
Dear Dana,

I had a rabbit with a serious blockage of hair, mucus and liquid this week. The emergency vet declined giving her pain meds because he said this would slow down the gut motility even more. The poor thing was in so much pain she was beside herself and died the next morning. I had some Turbogesic at home, but in taking the vets advice, I never gave it to her. Now I feel horrible.

Can you tell me which pain meds I can give which will not interfere with gut motility if this should happen again?

Thank you,
Amber    
Answer -
Dear Amber,

For the vet to deprive her of pain medication was unconscionable.  Torbugesic does *not* have a significant effect on gut motility.  It can affect respiration rate, but there is no evidence to suggest that it affects GI tract motility.  

Still, if he was unwilling to administer an opioid, then at least Banamine might have helped.  If the bunny had a true blockage, then pain medication would not help her.  The only treatment for an acute blockage of the stomach is to gavage the bunny in an attempt to remove the blockage.  (Gastrotomy is an absolutely LAST resort, as most rabbits do not survive this surgery).  If the blockage was in the instestine, then medical means (e.g., subQ fluids, lactulose, intestinal massage, etc.) can help. But if the bunny was in so much pain that she was suffering, then surgery might have been a kinder option.  I'm so sorry that you didn't have a vet who could help you more!  

I am so very sorry you lost your friend in this tragic way.  I wish there were something I could say to help, but I know how painful this is.  If you can describe your bunny's symptoms, I might be able to tell you whether this was an acute blockage or not.

I hope this helps some.  Please write back if you have more questions.

Dana
Answer -
Dear Amber,

This is a terrible tragedy, and I am so very sorry about your loss.  I'm not sure I'm understanding this correctly, so please tell me if I'm wrong.  But is the vet suggesting that the bunny went into ileus due to the pain of a spay operation?  And that this spay took place only three days prior to the bunny's death?

I've never heard of a bunny going septic from ileus after a spay quite that quickly, although it's not impossible.  If the entire abdominal cavity was septic and necrotic, it really sounds as if something else was going on.  How experienced was the vet who did the spay surgery?   Is it possible that s/he accidentally breached the intestine, causing peritonitis?

Peritonitis is incredibly painful, and certainly could have elicited ileus--but that would be a secondary cause of problems if there was peritonitis, which can kill within 12-26 hours of intestinal breach.

I'm sorry to keep pestering you for details, but I'm still not clear on the entire sequence of events, from your description.  How long ago was she spayed?  And how long after the spay did you first notice that she was feeling poorly?

I'll wait to hear from you.

Dana

Answer
Dear Amber,

Man.  How devastating this must be.  I am so sorry.  

Like you, I really doubt that the spay caused her to "shut down."  Generally if a spay or other surgery causes a bunny that much stress, you see symptoms (e.g., ileus, general lethargy, inability to "rebound") immediately after the surgery.  If she was feeling great and acting fine, then it wasn't the stress of the surgery that did this.  

However, I *do* have to wonder if the vet who did the spay--as experienced as she was--might have had an accident that even she did not notice.  I really can't even begin to guess.  It might have been something that was already happening inside Short Stop.  But it also could have been something that happened during surgery.

Did you ever ask the vet who did the spay about the odd-looking suture?  The fact that the second vet was curious/suspicious about it does raise a wee red flag.  I certainly am not accusing your expert bunny vet of anything!  I wasn't there, and I have no idea what happened during the surgery. But it does make me wonder.

Anyone--even the *best* vets or physicians--can make mistakes.  I just have to wonder if that happened, and if so, if she had any inkling that something went wrong.  She might not tell you if she did.  She might not even admit it to herself (I have a fantastic vet here, but I have to wonder whether she would admit it to me if she made an error that resulted in the death of a bunny; there's a good bit of ego involved in becoming a vet or a physician.)

I just don't know.  It really is a mystery, and unless your vet is willing to "come clean" if there really was a problem, then we might never know.  It might have been some unforseen infection lurking there, waiting to happen.

I wish I could give you a better answer.  But in some cases, there just isn't one.  In any case, I am so very, very sorry about this devastating loss.  I do know how it feels.  But please try not to beat yourself up about her passing.  You *were* doing the right thing, and we can't see the future.  

She will always be in your heart.

Take care,

Dana