Gastric stasis again

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Sammybunny

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Hello all,
Seems like I have been having alot of issues lately. Well Sammy had a bladder infection a few weeks ago. I did have bloodwork done and everything else was ok. We put him on Baytril and benebac and it resolved. Well a few days ago, he was acting a little different, and I felt his tummy, he had loud rumbles so I thought he was having gas and gave him some gas x. Well he isn't pooping and hasn't really pooped for 3 days except maybe a small amount yesterday.
After the first day I started some oral fluids and more gas x. I took him to work and snapped an xray and sure enough it looks like stasis again. He does have some fecal material lower down but isn't blocked as far as we can tell. I have him on reglan, lactulose, sub q fluids and metacam. This is so frustrating and we started the reglan 2 days ago, the lactulose yesterday. I gave him a warm water enema yesterday and today, and still no poop. In the past this normally resolves it. I am really worried because of the no poop.
He is still nibbling on food, although not eating as much. He also grinded his teeth twice so far. I feel so bad. He isn't hospitalized because I can do everything at home and the vet and I agreed he's be happier here.
We also are suspecting that he has megacolon. The more I researched it, the more he fits the textbook description. He is white with the color around his eyes, he has always had unusual poops that are larger than normal despite a good diet ect. The prognosis doesn't look good if it is megacolon. I don't want him to suffer but don't want to put him down either. He doesn't look to awful although I can tell he is uncomfortable. He is alert and grooming himself and did hop out of his cage today. I guess I will fight as long as he will. I don't want to give up yet but am running out of ideas. I know that lactulose takes 24-48 hours before it takes affect and I gave the first dose last night so we are coming up on 24 hours. Oh and I have been monitoring his temp and it is between 102.3 and 103.3 so still good. He did eat a papaya treat last night but none tonight. Any ideas? Surgery is not an option as we discussed that he probably would survive that su we are left treating medically.
 
Fluids and fibre. I don't hold by Reglan or much else you're giving him. I'd stick with fluids and Critical Care and depending on his reaction to veggies, a lot of wet greens and other veggies, but others may say just stick with a lot of varieties of hay.

My black-ringed-eye bunnies with megacolon symptoms did way better with a lot of veggies than they did at their former home with just hay and water.

How does yours react to veggies?


sas :?
 
He loves his veggies and gets about 2 cups of them a day. He gets about 2 tablespoons of pellets which I stopped when the issues came on. I offer many kinds of hay and he was on an oat hay kick but has since stopped that. I have to get my hay from the feedstore in mini bales as it is fresher. He absolutely hates petstore hay and won't eat it. He isn't a hay eater to begin with and it is frustrating as I know that would help him.
Well after I posted I did the last treatments of the night. I gave him some more gas ex, about 100 mls of LRS subcutaneously and about 10 mls of water mixed with pedialyte orally. He actually was willing to drink this time from the syringe which was different as he hates me syringing fluids but I do anyway. I did give some lactulose but no reglan. I also gave a warm water enema to soften anything lower. I checked his temp and it was 102.9 which is normal. Once I put him back in his cage, he groomed himself for a bit and then proceeded to eat a bunch of italian parsley, some kale(I know it isn't good in large quantities but it is a fave), some mint, and half a romaine lettuce leaf. He then went to his crock and drank some plain water. He went to the box and I was hoping for poopies but alas there was just urine. I am just praying for poop now. He is acting a bit brighter after treatments but no poops and he wont take a papaya treat still. The greens are a bonus though, plus I wet them with water for extra moisture. Keep Sammy in your thoughts.
 
I think you're going to find a lot of varying opinions on all the treatments, so honestly the best method is to keep a journal and try and figure out what works best for Sammy.

E.G.: This board is not generally very receptive to gut motility drugs, I personally don't like them, I think they're over-prescribed and can be used inappropriately, but maybe YOUR bunny's disorder is a case where it really is needed. There is also Cisapride (which I believe is more geared for moving the contents of the stomach into the intestine) as well as Reglan (which I believe is geared for moving it through the intestine). Maybe both or maybe neither are best. That's a Vet's call after reviewing the history and the mechanics of the problem.

Ditto with Lactulose, which is a sugar and not always recommended here -- although it does work to draw hydration into the system.

Our resident RO expert, Randy, HATES gut motility drugs and probably won't like the Lactulose much either (although I haven't checked his posts).

Dana Krempels, a biologist and very well-known bunny expert, swears by the gut motility drugs and Lactulose however.

Kathy Smith, also a member here, also recommends Epsom Salts in her Rabbit Health in the 21st Century book (with adequate hydration). That's probably worth a shot.

I'd keep pushing the hay even if he just nibbles at it. Variety may be inspiring. Will he eat grass? My vet recommends that for the non-hay eaters.

The huge plates of soaked veggies did work for me, although the three bunnies I had here with that issue (two sisters and a brother, black/brown eye rings and spotted backs) didn't have huge problems, just a lot of irregular, huge poops more so than frequent stasis incidents. But they improved here.

How is Sammy's weight?

You do sound like you have a great handle on it.

Other than huge plate of all kinds of veggies -- and I do feed my hay-challenged dwarf too much kale, but I'm convinced the pluses outweigh the minuses (I just let her 'detox' every four days or so) -- Epson Salts, grass and a lot of exercise, not sure I can suggest much else. See what works for Sammy.

It does sound like he's doing better. The poops will hopefully be along shortly.

I'm editing this post to add a link to a Dana Krempel page, here:

http://en.allexperts.com/q/Rabbits-703/2008/2/intermittent-blockage-GI-upset-1.htm

What I find particularly interesting is the reference to a urinary tract issue, which is something you also referenced with Sammy and seems to come up often. Coincidence?

Keep us updated!


sas :clover:

edited to add more info and delete irrelevant text
 
Pipp is correct....drop the Reglan, drop the lactulose and don't do an enema. I don't particularly like the idea of epsom salt either. This is an example of over reacting to a simple situation.Remember things need to change slowly with a rabbit.....the idea is to"steady the ship" By doing all the things, it creates chaos in the gut when you need stability. Reglan (Metaclopramide) is such a dangerous drug. Just do a quick search of the many very serious side effects in humans. And it's more dangerous in rabbits. I have seen bad things happen so many times.....and I have the utmost respect for vets....but the use of motility drugs is a "win win" for them regardless of the outcome for the rabbit. Lactulose is a synthetic sugar....and if you add sugar to a compromised gut, you just make for a bigger problem. An enema has to be done with a very steady hand. The walls of the GI are very thin and are already stressed in a stasis situation....as with many invasive procedures, one slip can be bad. I have never administered an enema to a rabbit and I have had rabbits in total gut shutdown for over a week at a time. The proper response to stasis is two fold......hydration...and the rule is hydration before nutrition. An animal, including a rabbit, will die from organ failure induced by dehydration long before starvation. And the idea that if a rabbit doesn't eat or poop in 24 hours is always fatal is a total farce. That "legend" comes from a time that people didn't know about rabbits and didn't have them inside to watch them. They may have died within 24 hours after someone noticed they were sick, but the reality is that they had been sick for quite some time before it was noticed. The other attack on stasis is find the root cause. Stasis is a symptom, not a primary ailment. It is always the result of something else. And Pipp's idea of charting is something I have preached for a long time. Look for patterns...especially time. When something is happening on at fairly regular intervals.....look for something with that cycle...like maybe parasites.

Randy
 
I forgot to mention massage... very long tummy massages have worked well with my bunnies, it helps relieve the gas and can stimulate the gut.

And Randy brings up the major point of the stasis being a symptom. The urinary issues that often accompany stasis episodes can be the real trigger, although so can gas attacks, infections, tooth issues, etc -- pretty much anything that can cause pain.

That said, I still see too many urinary issues associated with the stasis in conjunction with the 'mega-colon' issue. It may just be that UTIs or bladder stones or whatever may be a common trigger, but I still find it odd.

Did the vet take Sammy's temperature?

Also... any sign of straining or distress/discomfort in the litterbox when he's peeing?

(And apologies for any changes in my post from the original, I fiddled for longer than intended!)


sas
 
Well I came home at lunch to do treatments so I will give a quick update. Sammy is still relatively bright and alert. He did grind his teeth a little this morning, but the funny thing is he ate a bunch of greens I gave and drank a bunch of pedialyte water on his own. He is still subdued though and still no poops! This will be day 4. There was a smear of soft stools that might have been his as his companion is having normal poops. I syringed more pedialyte water and got about 10 ccs down before he had enough. I stopped the gut motility drugs for now and gave some baby gas ex. His stomach is still uncomfortable and gassy but he doesn't struggle when I massage it. There was no blockages as of tuesday. I guess it is still wait and watch. His temp is still good at 103.2. He's never gone this long without pooping though. He is still eating and drinking.
 
It may be good to do another x-ray. It's possible that some object was obstructing the intestines but you couldn't see it, and now it may be more apparent now that he has eaten a bit and drank a lot. With the food going in, it has to come out, unless it physically can't. I would think that what you've done so far would fix it for him, but it hasn't, so something very serious in his intestines needs to be considered.
 
tonyshuman wrote:
It may be good to do another x-ray. It's possible that some object was obstructing the intestines but you couldn't see it, and now it may be more apparent now that he has eaten a bit and drank a lot. With the food going in, it has to come out, unless it physically can't. I would think that what you've done so far would fix it for him, but it hasn't, so something very serious in his intestines needs to be considered.
Click to expand...

I also was wondering if it there could be a blockage that is difficult to detect. You are sure there is not a blockage :??

maybe another x-ray as Claire suggested


I agree with Randy and Pipp..sounds like initially the treatment was over kill as I cannot imagine giving an enema to a rabbit on a gut stimulant ..actually cannot imagine giving an enema at all

What about the biosponge ..can you get a hold of any?

Also wondering if Flagyl would be helpful???
Ihad a (self diagnosed) " mega- colon bun who periodically went into terrible stasis which was extremely difficult to resolve

Good luck and keep the fluids going in . Are you giving sub q fluids. ?
 
Well we are still at the same point. He is still alert and moving around although a little less. He did come out of his cage on his own and hopped around a bit. I encouraged him to hop around to help his gut. His treatments have continued with the metacam twice a day( I am making sure he is hydrated), simithicone, SQ fluids, and oral fluids. I stopped the lactulose and reglan for now. I massage his tummy which he likes and he was licking me as I massaged tonight. What is weird to me is that he continues to eat a bit on his own. He ate some parsley, mint, swiss chard and kale, plus a little alfalfa hay.( I normally don't feed alfalfa but I know he loves it as well as the kale) I would think if he was blocked he wouldn't eat. He is also drinking and peeing freely. I also listened to his tummy with a stethescope and I hear grumbles, not even loud violent ones, but they are there. I have read of stasis cases going for up to a week and a half without fecal pellets, I don't want that but I think he's still fighting so I am keeping up on the hydration and offering greens for hydration and nutrition till hopefully we get poop.
 
Man this is really weird. This morning Sammy was really bright and alert, but still no poop. His belly felt actually a little better. His temp is still fine. I did give him his morning treatments and then let him play. He was hopping all about like usual. He even did a bunny flop on his side which he never does when sick. I had them out longer so I could clean the pen and I watched Sammy and except for the absence of poop he is acting fine. He was chasing Charlotte, his cage mate, and was trying to hump her lol. I offered some greens and he ate like there was no tomorrow. He took a papaya treat and ate a small amount of pellets which were really for Charlotte but he pushed her out of the way. He is drinking from his bowl and acting for the most part normal. I would think he wouldn't be acting normal if he felt really bad. Maybe it will be just time before the poops come. He really isn't acting sick at all now. I just don't get it.
 
Yeah I was thinking that as well, I did back off the SQ fluids a bit because he is drinking more on his own and there was some residual fluids that went donw to his armpit. I don't want to overhydrate him either. His pee is kinda clear to light yellow. I'm happy he is feeling better, but was hoping to see poopies this morning. I guess I have to be more patient. Oh we did take another Xray yesterday, and there is food in the stomach and fecal material mixed with gas in the intestines, still quite a bit of gas, but he's not in bloat, although I figure if he was he'd be dead because that is an acute process. My boss who's a vet isn't real familiar with rabbits but is trying to help and he was consulting his books on exotics and there was a section on GI stasis and bloat in rabbits complete with xray pictures of each. He is in stasis, but we still can't see a real blockage yet. We stopped the motility drugs though just in case a blockage is there and isn't evident yet. I don't want to put him through surgery as that holds a poor prognosis. The doctor is very adamant on getting as much fluids orally as I can to hydrate whatever is in there. Plus the SQ fluids and gas x. He is leary of forcing critical care, but told me to offer greens and hay. He is eating on his own, which I figure he wouldn't do if real sick. We are also giving benebac too to try and normalize the gut flora. We aren't doning antibiotics yet as there doesn't seem a need for them at the time. I am also taking Sammy into the exotics vet if he isn't better by monday.
 
Are you keeping up with the gas x (simethicone)? With the gas in the intestines, and the gut grumbles, it might help some more.
 
Yup Im keeping up on the gas x as well. He is getting it every few hours about 2 dropperfuls. He likes the taste and takes it willingly. I also syringe water mixed with pedialyte at that time as well. He will drink about 8cc at a time before fighting the syringe. Right now he is eating more greens.
 
Yup I'm doing the tummy massages too. He is about the same today. No poops, but still eating drinking and hopping around. He does seem a bit uncomfortable as he will lay with his belly pressed to the ground but not all the time. His belly still feels very gassy to me and I've been giving gas x every few hours. He likes grape flavored pedialyte and has been drinking well. He ate a few strands of hay, but is eating his greens like no tommorrow. I would think that he'd not be eating by now so this is really weird. He does go to the box and is in there for a while with no poop just urine.
 
Too much simethicone can be constipating soI would not overdo it

I also recommend giving a probiotic

freshly squeezed fresh pineapple juice could be given ..maybe a 3 -4 cc several times per day.

Ialso strongly recommend getting another x-ray tomorrow to see how his gut looks.

You may need to try another treatment ( although I don't have experience with either epsom salts or lactulose) if this continues.

I had a bun who had suspected megacolon who had several serious stasis issues which were difficult to turn around.
 
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