Rabbits/ec versus arthritis
QUESTION: Hi Dr. Krempels,
My 7.5 year old rabbit has bloat and is anemic and possibly in renal failure. Here is what has happened:
Sunday: Sunny skies, everything is great.
Sunday 11pm: He didn't eat his baby carrot, and that was weird. He also felt heavy in the middle. I gave him a fresh litterpan so I could watch for poops and stayed up most of the night with him giving him simethocone and getting him to hop around periodically. I thought this was stasis, which we;ve handled before and it usually resolves quickly if you catch it and act fast.
Monday morning: No poop, still won't eat, still felt heavy. I called the vet and got the earliest appt.
Monday 1pm: We show up early to sit in the waiting room in case they can get us early. They do. They check his temp and become very alarmed (93). They want to do subq and reglan. We asked for an xray prior to reglan in case there's a blockage. They said the xrays (which I have and can email you if it will help) showed a lot of air in (around?) his stomach, but no bloackage. So they give reglan, medicam, fluids (not sure the order).
Monday 6pm: No improvement except temp is up to 95. His blood test comes back showing anemia and possible renal failure.
Monday 9pm: More fluids, no improvement.
Tuesday 9am: No improvement, except as the vet is talking to me on the phone, a vet tech interrupts to say he is nibbling hay, so the vet says we should wait a few hours to decide whether to possibly put him to sleep (we would do anything for him, but we don't want him to suffer). I also ask to have the xrays sent to an expert in Columbus just to get a second opinion.
Tuesday 11am: We're headed to the vet to spend time with him when they call us to tell us he is pooping, eating lettuce, and hopping some.
Tuesday 12pm: They call to tell us that the expert said that they xrays looked like it was a complete obstruction. Surgery means a 50% chance of making it through, then of the ones that do, 50% die within 3-5 days, then of that 25%, many develop this again because of side effect of the surgery (cohesions). I asked the expert what she would do if it were her rabbit, and she said she would not do the surgery because his chances are even lower because of the amount of time. The vet says the same thing.
Tuesday 1pm: We go to check on him. He is very sleepy (but he's a on a heating pad, which he loves), but when I feel him, the thickness around his middle is much reduced. The poop looks just like his normal poop. The vet did say that some it had some mucous on it which is concerning. We ask for a new xray to see if the gas is better/obstruction is gone because of the eating/pooping. His temp is 99.
Tuesday 8:45pm: The vets calls to let us know that they did the xray and it looks a lot better, less gas and less I think inflamed stomach lining. He peed during the xray so they checked that, and it was dilute and contained a lot of red blood cells. They switched his pain med to something that's not medicam because of the kidney disease possibility. He is eating less but did poop again. His temp is 96. It sounds like it goes to normal-ish when he is on the heating pad, and if he moves off of it, it goes back to 95/96.
So, right now, I think we're just waiting to see how things go. I screwed up at the beginning thinking it was stasis and did not realize it was bloat until after the first vet visit. I wanted to ask if you have any advice in general and also specifically about the renal failure and anemia-- is it possible that once the bloat is gone, that the anemia and renal failure will go away too, or are those for sure separate issues? Thank you for any information!
ANSWER: Dear Carrie,
It sounds as if your bunny had a transient blockage that--fortunately--resolved on its own. Very lucky bunny. If this happens again, and appears to be in the stomach, you can sometimes shortcut the blockage by turning the bunny onto his LEFT side and doing gentle massage and vibration. This relieves pressure on a very sharp turn the small intestine makes just behind the pyloric sphincter, and can prevent a full-blown bloat.
It's hard to say whether the renal failure is related to the intestinal problem. Renal failure *can* be acute and transient, or it can be chronic and progressive. The anemia makes me worry that this is chronic, since the adrenal glands stop producing erythropoietin, a hormone essential for red blood cell production, when the kidneys fail.
If he's eating and pooping and acting pretty normal, I'd say keep up the current treatment. His inability to maintain normal body temperature (101-103 oF) is worrisome, too. That suggests his body is having trouble maintaining homeostasis. This could be due to the shock of the blockage. But if that is resolved, you should expect to see him getting better at keeping his body temperature up. It really needs to be up over 100, at least. I hope they are warming him up sufficiently. Just doing that could turn everything around for the better.
I hope he will be fine, soon. If you're bringing him home for supportive care, then here are some instructions for taking his temperature:
Have the vet show you how. It's better if he comes home with you, if possible, where he will get 24-hour observation and care.
Thinking healing thoughts.
---------- FOLLOW-UP ----------
QUESTION: Hi Dr. Krempels, thank you so much for your advice. Jonathan did make it through the bloat and started regulating his temperature again (over 100), but the morning he was supposed to come home he had a large seizure and passed away. The vet suspects e cunculi and we're waiting for results to come back. We miss him a lot, he was my first pet on my own and my constant buddy.
I have two other rabbits. One is 6.5 (Franklin) and seems to be doing great. The other is 9-or-10-or-11 (Lisette), and she is eating and pooping and in good spirits. However, she has become less mobile and we thought was arthritis, but now with the e cunculi suspicion with Jonathan, we're wondering if that is what is going on for her too. There's no head tilt, no weird head movements, no twisting body, but she has trouble getting out of her litter pan (we put down a towel under fleece for her for when she doesn't feel like it), she doesn't jump on high things, she feels thin (I started giving her extra pellets when I noticed that), and she is getting clumsy-- she fell when she made a not too hard turn. The clumsy part is what put me in a cold sweat. We're taking her to the vet tomorrow morning. I was thinking I should ask for an xray to see about the arthritis and 4 weeks of Pancur in case its ec (I found that in one of the other AllExpert posts)-- is there anything else I should ask about? Should I ask to put my healthy 6.5 year old on Pancur too just in case? His pen is next to hers and they have 12 feet of ex-pen in common (living room is pretty much bunny room). They've been so healthy for so long, this is all happening at once. Thank you for any information!
PS. Is there a charity that you like that we can make a donation to in your name? You have helped us several times over the years, and we really appreciate it. Thank you so much!
I am so very sorry about Jonathan's passing. He was lucky to have such a caring "mom" who took such good care of him to the very end. I hope the other bunnies will help comfort you in this hard time.
I would ask about putting your E. cuniculi-suspect bunnies on Panacur and possibly ponazuril, as well. We have had very good results in combining the two drugs. Ponazuril is a bit expensive, but you can now usually buy a single horse tube that will last a very long time.
Your vet may able to get it for less money, but you'll have to find out from the vet.
As far as prophylactic Panacur is concerned....the jury is still out. If she's not showing signs of trouble, then even if she has the parasite, she might be fine all her life. Some bunnies show signs, others never do. And it's not certain that Panacur actually *kills* the parasites; it may just suppress them to some degree. Not enough research has been done on this yet.
It probably won't hurt to put her on it, but I prefer not to medicate unless there is clear need.
I hope this helps. Please accept my condolences for Jonathan.
P.S. - Information for donation to our rescue should appear below my signature. You are very kind to offer to help us.