bladder stones/sludge

[swanlake]

Hey! I haven't been on in quite some time...

Anywho, my mother has a coworker with a rabbit that appears to have urine scald, as well as some bladder stones/sludge. I read the literature as well as forwarded iton to her, but there seems to be a lot about diagnosis, and not so much on treatment.

The vet she went to is not a true rabbit vet, as they will see rabbits but don't have a real rabbit trained vet. I am going to tell her about the vet I go to which has doctors well versed in rabbit care. You could see the stones in the xray, so the diagnosis should be right. Although the doctor called them 'crystals'...

I just want to make sure they give her the right advice, if any advice on how to treat her rabbit. Your help is much appreciated!

 

[tonyshuman]

This site has some very good links that you might want to forward on, if you haven't already.
http://www.medirabbit.com/EN/Uro_gen_diseases/Urogenital_main.htm

Most important will be lots of fluids, sub Q for sure, and pedialyte orally probably. Add a touch of cranberry juice to a second bowl of water for the bun. Pain should be managed with a narcotic analgesic, like Tramadol or buprenorphine, instead of a nonsteroidal antiinflammatory, like Metacam (meloxicam). There are additional drugs that can be used to improve kidney function, but you'll need an experienced rabbit vet for that.

For the scald, I have heard good things about Preparation H, udder balm, and baby cornstarch, depending on how extensive the scald is. If there's a ton, she may want to do cornstarch just to keep the area dry and let it start healing a bit. You wouldn't want to coat an entire bunny's bum in one of the ointments.

 

[Pipp]

:yeahthat:

And yay! Nice to see you, sorry its in the Infirmary.

Hope your crew is well.


sas :bunnydance:

 

[Pipp]

Check out Amy27's about-to-be-published Library story here with updates from Billinjax.

http://rabbitsonline.net/view_topic.php?id=43493&forum_id=16


This is the story written up by Amy in a nutshell:

Chase’s Story

Chase had been to the vet in September 2008 for her yearly check up. Everything went great, the vet found nothing wrong. In October 2008, I woke up and let Chase out of her caged area. I noticed she would not eat. She kept moving around trying to urinate on the floor, which is unusual because she is litter box trained. She could not lie down for more then a few minutes without switching positions. I knew something was really wrong and she was in pain. I had to get her to the ER vet. It was a Saturday and her regular vet was closed.

When I got to the ER vet, they took Chase in the back. The vet tech came out and said Chase is eating hay. Their rabbit savvy vet does not work emergency hours. The vet on staff had no idea about rabbits. The vet tech recommended I take Chase home and take her to a rabbit savvy vet on Monday since she was eating, and they would not charge me anything for the emergency visit. I was furious. I knew something was wrong with my rabbit and I was not waiting two days for her to get care. I told the vet tech this and that I wanted an x-ray done on my rabbit at the very least. We had no idea what we were dealing with, I could not risk taking her home and having it be a serious issue. The vet took the x-rays and saw a large white circle in the bladder area. The vet on staff had no idea what it was. She emailed the x-rays to the rabbit savvy vet at home that works at the hospital. The rabbit savvy vet, Dr. Ogleesbee, knew it was a bladder stone. They could not remove the stone but gave me medications and fluids to keep Chase comfortable until Monday. The pain medication was Metacam. They had given Chase some pain medications at the vets that would last about 12 hours; I am not sure what it was though.

The weekend was horrible. Chase was very uncomfortable. I called the emergency vet to try and get stronger pain medication but they wouldn’t give me any without me bringing Chase back in, it was a 30 minute drive. I decided not to bring her back in. I felt like an hour ride to and from the vets, would make her feel worse. I was so upset that the vet wouldn’t give me anything stronger when Chase had just been there. I slept on the floor of her room that night with a flashlight and would wake up and turn on the flashlight so I could see her and make sure she was still alive. It was a horribly long weekend.

On Monday morning, I took her to her regular vet who removed the stone. Chase had already been off pellets for several years at that point due to her being over weight. Her diet consisted of unlimited hay and veggies. The vet thought this was a one-time thing since she had a good diet that was low in calcium. The vet sent me home with Metacam and an antibiotic. The stone was huge. It filled up most of her bladder. The vet had no idea how Chase had not stopped eating sooner or showed some signs of pain. The stone was sent off to be analyzed and it came back as being calcium carbonate, which we had assumed but I wanted to be sure.

Chase recovered well from surgery though I almost had a heart attack everyday. I monitored everything she did. Then life got back to normal.

January 2009, it was a normal Saturday. I was on the computer and noticed the same symptoms in Chase. She was urinating on the floor, moving around as if she was uncomfortable. I knew what it was. I loaded her in her carrier and we took off to the emergency vet. The x-rays confirmed another bladder stone, almost as big as the first one. Again, I was given medication and told to have her regular vet remove the stone on Monday.

That weekend was horrible. Chase would not move. She laid on the tiled part of her floor. I warmed towels in the dryer and put them around her to keep her body temperature up. I did not think she would make it until Monday. However, I did not want to take her on another 30-minute car ride back to the emergency vet that would do little for her. I knew the car ride would be painful for her. I just prayed she would make it until I could get her more help. It was another long sleepless night for me.

Monday morning the stone was removed. The vet called me after surgery to tell me Chase came through surgery okay but she had some concerns. During surgery, she noticed Chase’s bladder was really thin. It showed signs of distress. Her bladder could not handle another stone. She told me she thought Chase would need to be put to sleep. I bawled as I went to pick up my baby. When I got there, I talked to the vet and said I was not willing to put Chase to sleep. She had so much life in her.

I got home, which was a 30-minute car ride. When I took Chase out of her carrier I noticed watered down blood all over the blankets and Chase. I immediately called the vet who said to bring her back in. Another 30 minute trip back to the vet and they told me it was normal, it was just serum. I then asked the vet tech to give Chase some pain medication before we started the 30-minute car ride back home, that is a lot of time in the car for a rabbit that just had major surgery. The vet tech asked why I did not bring her pain medication with me. I told her I did not think of it, I thought she was bleeding out of her incision and just wanted to get her back to the vet ASAP. The vet tech was really nasty and said well we just cannot give you free pain medication. I said that is fine, I will pay for it; I do not expect free medication. However, my main concern is the pain my rabbit is in. I then started crying I knew my baby was in pain. The receptionist then stepped in and Chase got some pain medication to help with the car ride home. I was such an emotional mess at that point. I bawled all the way home. Which looking back now I know upset Chase more.

Chase had a urinalysis done when the stone was removed. This was the result:

CBC: WBC 6.1 RBC 4.9 HGB 11.1 HCT 31 MCV 65 MCH 22.8 Comment says Polychromasia +1

Differential: Heterophil Count 2623, Lymphocytes 3416, Monocytes 61, Eosinophils 0, Basophils 0, Platelet Estimate Adequate Platelet Count 293, Comment blood smear reviewed by technologist.

Comp, Mammalian Chemistries: SGOT (AST) 22 Comment: The chemistry results were calculated from a times two dilution which may falsely decrease the calcium. Electrolytes may also be inaccurate because of sample dilution. SGPT (ALT) 40, Total Bilirubin 0.0 verified by repeat analysis, Alkaline Phosphatase 28, Total Protein 5.8, Albumin 4.0, Cholesterol 14, BUN 22, Creatine 1.0, Phosphorus 7.0, Calcium 12.6, Glucose 326, Sodium 160, Potassium 3.8, Chloride 112, CPK 1094, Globulin 1.8.

Histopath Report: Source/History: Spayed female rabbit. Age not indicated. Second bladder stone in three months. Stone analysis 100 percent calcium carbonate. Incisional biopsy of bladder wall submitted, all tissues processed.

Description: The specimen is serially sectioned and examined in its entirety and four step levels are examined. The transitional mucosa is diffusely moderately hyperplastic and somewhat spongiotic appearing. There are areas of erosion and probablt ulceration of the mucosa present with underlying stronal hemorrhage. The submucosal stroma is also irregularly expanded by edematous areas with moderate patchy mixed inflammation observed. Lymphocytes and plasma cells predominate with fewer heterophils. Scattered hemosiderophages are also observed. No infectious agents are seen with H&E stain.

Microscopic findings: urinary bladder: Chronic, hyperplastic, erosive and midly hemorrhagic cystitis with submucosal edema.

Comments: Rabbits may have calculi within the bladder, urethra, kidney, or urter. Dietray management is an important part of treating and preventing calculi of the urinary system of rabbits. The alkaline PH of rabbit urine as well as the generally high concentration of calcium in the urine increases the chances of precipitation and calculi formation. Decreasing dietary calcium is recommended and this is done by diets of grass hay and green vegetables with reducing pellets. Vitamin and mineral supplementation should be discountinued. Also, many rabbits with urinary calculi are overweight and increased exercise and decreased total caloric intake are also recommended. The changes with the bladder wall in this case are not specific but typical of those occuring secondary to the preserve of urinary calculi. There was no evidence of neoplasia.

These results did show Chase’s glucose level as being high. However, the vet felt that was due to stress. A normal glucose level in rabbits is 78-155.

Seven days later, I take Chase in to get her stitches removed. The vet does an x-ray at that time and bladder sludge had already started to form. Seven days from the time, she had the stone to remove! That is when I really understood what was in front of Chase and I, this was going to be no easy battle. The vet again recommended putting her to sleep. I refused and stated I wanted to see someone with more experience. She referred me to Dr. Ogleesbee, which is the exotics vet who works at the ER I had taken Chase to both times. Though we had never seen this vet before as she only works 8-5 Monday-Friday. Dr. Ogleesbee taught exotics at The Ohio State University and has a special certification in exotics. I set up an appointment with her as soon as I could get in. The vet gave me sub q fluids to hold Chase over until her appointment. They showed me how to do it in the office and I knew I could not do it. Two vet techs had issues doing it. Did I mention Chase is very stubborn and the vets even have problems picking her up or holding her? She has a mind of her own and has almost been dropped by vets and vet technicians more times then I can count. She is an ornery little thing. I freaked out when I got home and then knew I needed help. I emailed the local college universities and every vet clinic in the area asking for a vet tech or vet student that would be willing to come to my house and help me give the sub q fluids. I was willing to pay or this. I found a great vet tech that has helped me many of times since with both of my rabbits. I was so lucky to find her.

I went to see Dr. Ogleesbee. She stated that this was an extreme case of bladder stone/sludge, she had never seen such an extreme case. She agreed with my other vet, there might not be anything they can do for Chase. She took Chase in the back to x-ray her and I lost it. I cried so hard I know other people heard me. I waited until Chase was out of the room and then I did not care. I just let it all go. The vet came back, I think after she heard my sobbing calm down. Chase still had the sludge. She wanted to up the sub q fluids and gave me pain medication. She thought if Chase did make it through all this, she would require sub q fluids for the rest of her life.

By this point, Chase had had blood work and urinalysis done. Everything was normal. No one could figure out why she was getting bladder stone/sludge. She did not have a high calcium diet. I tried fresh pineapple to help the acidic pH. I also tried soaking her veggies for an hour so they could absorb as much water as possible. Though this does take away the beneficial water-soluble vitamins, I knew it was more important to get fluids into Chase.

Chase was never a big water drinker. However, I tried everything to get her to drink. I flavored her water. I made my own cilantro-flavored water. She had seven water bowels and bottles in her caged area. I even tried a cat water fountain. She just refused to drink water. I also tried using filter water incase she was getting calcium from the water.

Chase went back to her follow up appointment with Dr. Ogleesbee February 7, 2009. The goal was for her urine SG to be between 1014-1020, it was 1071. An x-ray was done and her bladder looked better. The vet seemed a little optimistic that may be Chase would be okay. At this point Chase was getting 150 ml of sub q fluids every other day and .5 of metacam twice a day.

Chase’s next appointment, February 12, 2009, showed no improvement on the x-rays of her bladder sludge. She went back up to 150 ml of sub q fluid everyday. The vet also prescribed Lasix. A drug she has never used for bladder stone/sludge rabbits, generally she has used it with rabbits that have CHF. Since rabbits with CHF do not live that long after starting Lasix, the vet did not know what long-term effects the Lasix could have on Chase. However, we really did not have a lot of other options. The Lasix is a diuretic that would increase Chase’s output and hopefully get her to drink water. Even with the Lasix, Chase still refused to drink water. I was still giving sub q fluids and soaking her veggies in water. I did notice an increase in her urine output but was constantly worried she was becoming dehydrated.

This was a very hard period for both Chase and I. She hated the sub q fluids. She even bit me one time. She would grunt and make noises. It broke my heart to see her so upset. I had some great suggestions on the forum about seeing a holistic vet. With as frustrated as Chase and I were, I decided to give it a try. I called the holistic vet near me and the receptionist was very rude. She even laughed at me that I wanted to bring a rabbit in to be seen. This really did not help my frustration. I could not believe someone would laugh at my attempts to help my rabbit. Especially when their website stated they saw pocket pets! I tried to let the holistic approach go, as I did not feel comfortable making decisions of holistic things, I could give Chase on my own and my vet was not knowledgeable in holistic medication.

In February 27, 2009, I took Chase back for another follow up appointment with Dr. Ogleesbee. The Lasix had worked, her bladder sludge had decreased. Chase still had calcium buildup along her incision in the bladder. The vet said it was normal that calcium would be attracted to the incision and that may never go away. The vet wanted Chase to stay on the Lasix and we were able to decrease the sub q fluids to every 3[sup]rd[/sup] day. Chase really enjoyed the break of not having sub q’s everyday. However, I still struggled with getting her to drink water. Even on the Lasix and trying flavored water, she just would not drink it.

Chase’s next follow up appointment in march 2009 showed no sign of bladder sludge, she had a normal bladder. I was so happy. Her sub q fluids were decreased again to once a week and she was still on the Lasix. Chase had lab work done at this visit. Just to make sure the Lasix was not causing any problems. The vet had told me that Lasix could cause a decrease in potassium so I tried to give Chase small pieces of banana to keep her calcium up.

Even though I knew the x-rays showed Chase was better. It did not stop my mind from examining her every move. I was constantly watching how she sat, what she ate, and how she acted. It was torturous. I kept waiting for something bad to happen. Could we really have beaten this?

The vet called me with Chase’s lab results and everything was normal. The Lasix did not appear to be causing any problems. The vet also thought it would be safe to stop the sub q fluids. Chase was getting two huge veggie salads a day that had been soaked in water. We were hoping that would be enough water intake for her.

At Chase’s next 1 month appointment, she was still sludge and stone free. However, the lab results showed her potassium levels were low. The vet said her potassium has to come back up in 3-4 weeks or we may have to take her off the Lasix. That was devastating to me; I know the Lasix was keeping her stone/sludge free.

We also had the issue of Chase’s weight. Due to me increasing her veggie intake and giving her a small piece of banana every night. She was gaining a lot of weight. She gained 8 oz in one month. She was now up to 6.9 lbs when she should be about 5 lbs.

Chase went back to the vet for another follow up in July 2009 and the sludge had returned. The vet asked me to start sub q fluids again but I just could not do it. I asked the vet to give me one month, see if I can get it to go away without sub q fluids. Chase hated it and I did not want to put her through it again. The vet agreed to give me one month. Chase’s lab results came back normal, her potassium had come back up. She would continue on the Lasix.

Chase went back to the vet in August 2009. The sludge was still there. The vet and I discussed increasing the Lasix. I was very hesitant to do that, as the vet did not know the long-term effects Lasix could have. Chase was still acting like her normal self so I decided to wait and see what happens before increasing the Lasix.

Chase began chewing everything in my house. In this strange compulsive way. It was as if she could not help it. She was eating holes in the dry wall, she was eating huge holes in the carpet, all the corners of the walls were eaten, and the baseboards were also eaten. This was not like her. I tried to talk to the vet, that something was missing in Chase’s diet. This was not normal, I really felt like Chase was trying to get something out of eating everything. The first time I mentioned this to the vet, she dismissed my concerns. The second time I researched pellets, and took a list of pellets, in I wanted to try. I really felt something was wrong. The vet liked the Oxbow Organic Rabbit out of the pellets I brought in. I started giving Chase 1 oz every other day.

Chase’s next appointment in October 2009, showed her bladder looking better then it ever has. The vet was really surprised. She did not like me feeding the pellets and was surprised that when feeding the pellets, her bladder sludge actually got better. Chase continued on the Lasix.

In December 2009, Chase went back for another follow up. The sludge was still gone. However, she gained another 1lb. The vet was not happy. She was now up to 7.5 lbs. We decided to wean Chase off her Lasix. I was also going to wean her off the banana and all the veggies she was getting. I hope that this would help her lose some weight.

In January 2010, Chase had another vet visit and she was still sludge free, even without the Lasix. The vet cautioned me on getting my hopes up that Chase was cured. However, I could not help it. Chase was off the Lasix and still sludge free. I was so happy.

April 2010 Chase went for another check up. The sludge was back. Chase was put back on Lasix.

In May 2010, Chase went back to the vet. The sludge was gone. We decided to cut the Lasix dosage in half. Hoping the dosage would be enough to maintain a sludge free bladder.

Here are the thread that go with her story:

http://rabbitsonline.net/view_topic.php?id=43493&forum_id=16&highlight=bladder+sludge