Expert: Dana Krempels, Ph.D. - 8/30/2008

Question
History:
Rescued rabbit Ling Ling, Female dwarf  2.5lbs dislocated vertebrae at the end of the rib cage.
Rear legs paralyze due to being released then getting hit by a car.

We have taken care of Ling Ling and her bonded mate for about 2 years. She is alert, eating, fecal pellets, urinating all normal.
I was chosen to take care of Ling Ling because of my engineering background. She needed a special cart/wheelchair.
I have designed a light weight corset with integrated back support and wheelchair. She also receives daily leg excises.
She now can kick her legs and can hold them straight up when I ask her,and she is on her back.
I make these statements to show she is getting excised.

About 2 months ago she started to have what looks like CECAL DYSBIOSIS. Smelly soft stool about every 12 to 24 hours.
It would last any where from 1 to 5 hours. Then back to normal fecal pellets.

She has been on Timothy hay (only) since the start of the ISS (intermittent soft stool).
I waited 2 weeks to see if there would be any improvement.

No improvement I then took her to a vet No.1 (off the HRS's rabbit vet list).
Diagnosis:
over growth of Clostridium
Drug of choice:
Metronidazole oral suspension .5ml/daily.

After 5 day there was no change. Call the vet she suggested to try Baytril.
After 2 days Ling Ling was having the soft stool twice a day now and more of it.

Called the vet again, now she is on vacation and nobody knows about her case loads.
Called the owner of the Veterinary Clinic (well informed rabbit vet). brought another
stool sample,
Diagnosis:
Clostridium
Drugs of choice:
Diarsany Paste.................................pea size/daily
Metronidazole ora Suspension.........point5ml/daily.
Albon Suspension...........................don't remember

Eight days later no change. Vet back from vacation. Told the vet Ling Ling is not producing normal cecotropes.
And after the round of soft stool there appears to be firmer and distorted cecotrops with a very strong order.

Then the normal fecal pellets will follow. I will not expect to see the soft stool again for 12 to 24 hours.

Another stoop sample.
Diagnosis:
Clostridium
Drugs of choice:
Metronidazole Chewies 62.5 mg 1/4 tablet twice daily.

After 10 days no change..

New vet No. 2 (off the HRS's rabbit vet list).
Another stool sample
Diagnosis:
Coccidia
Drugs of choice:
Cisapride(Propulsid) .2ml/twice daily
Trmethaprim-Sulfa .6ml/twice daily

Ask if  the vet had tested for Clostridium he said no But if I wanted he would.

Diagnosis:
No Clostridium

Call back in 5 days.....Did .....No change...Continue for the full 10 days ...Did......Still no change.

Brought in new stool sample. No Coccidia.....rabbit may need to remain on Cisapride... If I want!! ..... Doctor will call....Never did. ....Still no change. After 3 calls to the clinic receive a call from the vet 4 days later.

Vet No. 2 has no answer but would like to try meloxicam for 5 days. And that is where we are now.

I tried to send a stoop sample to a lab, but as I'm not a doctor they would not except the sample.

Any help you can provide would be appreciated. I live in the Washington D.C.area. I can overnight a stool sample.
or any other suggestion you may have.

Thank you
Don  

Answer
Dear Don,

Wow, Ling Ling is lucky to have such a caring, devoted "dad."

You've probably already seen this, but I'm including the link, just in case:

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

Yes, this sounds like cecal dysbiosis--but the condition is not a primary disease condition in and of itself.  Rather, it is a sign that there is something else going on in her body that's creating GI upset (usually a GI slowdown, so the cisapride was a good idea to try) that creates an environment conducive to the overgrowth of less desirable cecal denizens, such as yeast, or *dangerous* ones, such as Clostridium.

It's not uncommon for a somewhat inexperienced vet to misidentify common yeast as coccidia, so that may be what happened with that fecal flotation.  It's also not unusual for there to be *some* Clostridium in the sample, but to really get a positive ID, the vet would have to send the sample to a lab for culture and sensitivity testing, not just do a fecal flotation.

But the issue really isn't what's in the stool sample, as cecal dysbiosis is *defined* as this type of overgrowth.  The main thing is to determine what is *causing* Ling Ling's chronic GI slowdown, which results in cecal dysbiosis.  Once the proximate problem is found and addressed, the cecal dysbiosis should resolve on its own.

Her diet is probably not the problem here, since all she's getting is timothy.  And since you've not seen any improvement with the change to all-timothy, it's probably time to restore her to a normal, balanced diet:

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

The second most common cause of chronic cecal dysbiosis is pain/stress caused by the irritation from dental problems, especially molar spurs.  Has anyone checked her molars?  If not, this would be my recommendation.  Even a small spur can trigger this problem in a very sensitive rabbit.

But Ling Ling is also a special case:  a rabbit who has pretty much lost the normal use of her back end.  Over the years, this *could* result in a loss of intestinal tonus, and hence, she may be having this problem because of her primary paralysis/paresis.  If this is the case, then I'm not sure there will be an easy solution.  You can try gentle abdominal massage and keep up the GI motility drugs, but there's no guarantee that this will restore tonus, since abdominal muscles won't be able to exercise alongside the GI tract muscles.  It's all connected.

It's great that you've rigged her a system where she can have mobility!  That alone will help her emotionally, and probably has kept her well this long.  

I would find an experienced vet to check the teeth, and file any problematic spurs.  That could end the problem.  If not, then further diagnostics including bloodwork and a good listen to lungs, heart, etc. may detect an underlying condition that might trigger GI slowdown/cecal dysbiosis.

If all of that checks out, she may be one of the many buns who is going to have a chronic problem with this, no matter what.  To reduce its severity, limit any starchy snacks and give her unlimited, fresh grass hay and lots of fresh, wet greens, including fresh herbs such as cilantro, parsley, mints, etc.  (Some aromatic herbs actually have mild antibacterial activity, so they can help in a very general way.)

I'm glad she doesn't have coccidia (where would she have gotten it, anyway?).  But if she ever *does* have a problem with that--or if you have another rabbit who does, then please ask about administering ponazuril instead of TMZ or Albon, which are often quite useless in killing off these tenacious parasites.  Ponazuril will kill them in two doses, though we usually give five doses to be sure not to leave any resistant individuals to reproduce.

For some help with ideas on keeping her clean and comfortable without a full-on wet buttbath every day, please see:

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

I hope this gives you some ideas, and that Ling Ling will be better soon.

Take care,

Dana