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Rabbits/Emergency!!! Help! No vets a available here and Lots of Blood in urine

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QUESTION: My bun Ollie is 3 years old and is not neutered. Recently a month ago while on antibiotic oflaxacin she has some blood in her urine but because she was on antibiotic my mother who is an m.d.medicine herself thought it maybe cause of the antibiotic which was started for a slight uri. Now around 5 days ago she got some massive bleeding in her urine which didn't stop all day. We rushed her to the vet who did an ultrasound and said her bladder is inflated, 3 times more than normal size. So we started her in enrofloxacin and revisi as a blood coagulant. She also has urine burns. Now there are 2 problems. First here in India the vets know very little about rabbits. I've lost 2 of them cause of over dosing and fatal meds given. The second problem is, my vet over dosed Ollie on enrofloxacin. She was supposed to get around 30mg everyday (her body weight is 2kg) but was given 50mg. Due to which she stopped eating completely. Fortunetly I had some oxbow critical care on hand so I force Fed her. That was day before yesterday. After giving her the right dose yesterday she started eating after 6 7 hours. But there's still a problem. First is we don't trust the vets here so relying on their ultrasound is not a good idea. For the first few days there was a large amount of fresh red blood which got my mother worried as she said uti shouldn't see such large amount of blood in urine. The second is now that the vet has over dosed her, my mother plans to shift Ollie to orally given med that is bactrim since she feels enrofloxacin given as injectable is killing ollie's appetite and it's becoming worse than the disease itself. So Ollie has been on antibiotics for 5 days out of which 2 days she was over dosed on enrofloxacin . I was also giving probiotics with it and vitamin b complex and periactin to stimulate the appetite. Tomorrow we may shift her to bactrim (trimethasulfate/septran). I need advice as to what would be a good course of action now. I'm really worried and I've no idea who to rely on. I also suspect that there maybe a cancer or tumor which maybe causing the bleeding since she is still intact. There are no reliable vets. Though I got 2 ultrasounds both the vets said uti though they never commented on the reproductory system for whatever reason. I can get another ultrasound if thats what is recommended but I doubt anyone could give more info that way. My mom can send blood works to a human lab or urine if we are able to get that in a sterile container. Major cause of concern is if we should continue her on injectable enrofloxacin or shift to bactrim. Also there is no orally given enrofloxacin available in India.

ANSWER: Dear Poorvi,

This is a bad situation, and I do not see an easy resolution if you have no vets who can spay your bunny.  The most likely cause of copious blood in the urine of an intact female rabbit is uterine adenocarcinoma (cancer), and the only treatment for that is ovariohysterectomy (spay).  

The 25mg/kg dose of enrofloxacin your bunny got was high, but not lethally high.  We sometimes give "loading" doses that high, and then back down to 15mg/kg for the duration.  I doubt that the enrofloxacin was the reason for her inappetence; it could be due to the excessive bleeding, which could be making her anemic and weak.

I wish I had a magic suggestion that would make her well.  But I honestly think she must be spayed ASAP, and if she has been bleeding this long, she may not be a good candidate for surgery.  So you will have some hard work to do, finding a vet who can do this.  If you can find a vet willing to learn, there is a step-by-step video for veterinarians on how to do a rabbit spay here:

http://www.medirabbit.com/EN/Uro_gen_diseases/castration/Spay/Steril_en.html

I hope this helps, and send many healing thoughts for your bunny.

Dana

---------- FOLLOW-UP ----------

QUESTION: Dr.Dana the loose motions continue still. Its been a week she's been on critical care. Her stool sample show fungus in them but the ultrasound and x-ray show no adenocarcinoma. None of the vets are commenting now on her bleeding or her persistent loose motions. And the blood in the urine continues. Should we go directly now for a sterilization surgery? It that a good idea in her condition or is it her only option now? Because we are slowly losing her. Thank you for your time doctor. It is of great important to us that you reply as the vets here have no diagnosis and we are running out of time.

Answer
Dear Poorvi,

The loose stool could be due to any number of things.  I have known of veterinarians who misidentify coccidia as yeast (fungus), so if you can get the vets to double-check, that would be wise.  Yeast (fungus) is a normal occupant of the rabbit GI tract, but an *overgrowth* of yeast can be a problem.  It is usually caused by a GI tract slowdown, and is not a primary problem in and of itself.

To stop the diarrhea:

Give 1-2mg/kg of loperamide (Imodium) every 8-12 hours
Barium (about 1cc) will help soothe the inflamed intestines
Questran (cholestyramine resin) given about 1 hour *after* all other medications will help adsorb any toxins in the  GI tract and help solidify the stools.

Please also read:

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

for more details.  What you are seeing is probably NOT diarrhea, but unformed cecotropes due to cecal dysbiosis.

If the problem is coccidiosis:
20mg/kg Baycox (toltrazuril sulfone) once per day for at least 7 days
50-100mg/kg trimethoprim sulfadiazine twice per day for at least 7 days

Supportive care:

subcutaneous Lactated Ringer Solution:  10% of her body mass per day, given in three doses of 3.3% of her body mass each time.

Keep track of her body temperature.  Instructions for taking her temperature can be found here:

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

I hope she will recover soon.

Dana  

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Dana Krempels, Ph.D.

Expertise

I've lived with companion rabbits for more than 35 years, and consider them members of my family. I can answer any questions about the biology and health of rabbits, from the commonplace to the unusual. But please note:

RULE #1:
THE INTERNET IS NOT THE PLACE TO SEEK HELP IN AN EMERGENCY.

...it is an EMERGENCY.

Find a rabbit vet at www.rabbit.org/vet for immediate help, and don't risk your bunny's life by spending time asking questions online! If you can't get in touch with your vet, read these Emergency Sick Bunny Instructions.

If you have found a wild baby rabbit, please read these EMERGENCY INSTRUCTIONS FOR WILD BABY RABBITS and then use this link to FIND A LOCAL WILDLIFE REHABILITATOR who can give you the right advice.


RULE #2:
Help me help you! Please make your subject line informative if you have an urgent question. then LET ME KNOW IN THE SUBJECT LINE so I can give your question highest priority over non-urgent questions. If you don't do this, then I can't guarantee timely assistance!

For all the best, most accurate rabbit health, care and behavior information, visit The House Rabbit Society.

Experience

I have been rescuing and rehabilitating domestic and wild rabbits for about 30 years. I have written articles for many rabbit rescue publications, as well as for the veterinary journal, Exotic DVM. I own EtherBun, the internet's largest listserve dedicated to health, care, and behavior of domestic rabbits.

Organizations
Houserabbit Adoption, Rescue, and Education, Inc. (H.A.R.E., Inc.) president National House Rabbit Society (Board member)

Publications
Exotic DVM
Warren Peace (Journal of the House Rabbit Society of Miami)
Various newsletters of the House Rabbit Society, nationwide

Education/Credentials
Ph.D - Biology
B.S. - Biology
B.A. - English

Awards and Honors
Lightspan Academic Excellence Award for web site on rabbit health and biology
(http://www.bio.miami.edu/hare)

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