GI Stasis Help

[MyBunHenry]

Forgive me if this is a repeat thread or if I don't properly know the rules, I just need some help.

My rabbit Henry (she is female...I know the name is odd haha) was acting strange Thursday. I work with rabbits at my job and am sorta familiar with when something is up pretty early. I noticed she had eaten nothing from the night before and was oddly quiet so I immediately packed her up and took her to the emergency vet as it was after hours for my vet. They diagnosed her (with the help of an exotics specialist) with stasis. They started her on fluids, critical care, and meds and kept her overnight.

Friday morning I picked her up and took her to an exotics specialist. She looked her over and began immediately feeding her more critical care and hooked her IV back up. They said I had caught it early. They kept her overnight and when I called Sat morning they said she had started to poop and ate a little bit of hay so I could take her home.

All the rest of Saturday she was sluggish and was eating nothing on her own and not pooping really anything at all. I force fed her 3-3.5 tablespoons of critical care, gave her her metoclopramide, rimadyl, and also gave her some infant gas drops. Today (Sunday) I am seeing no improvement and I'm very worried. She's not grinding her teeth or hunched over but she is not eating at all (except what I force feed her) and definitely not pooping.

I guess I just need help or advice or anything anyone can provide. I'm really scared because I don't know what else to do. Any help would be so greatly appreciated!

 

[JBun]

Did the vet do any tests- xrays, blood tests, fecal? Was a blockage or impaction found to be present? Did the vet find a cause for the stasis?

Stasis is a gut slowdown, and just a symptom. There is always something else going on that causes it to occur, whether it is diet, molting, stress, dental, or other health issue causing pain. It's important to discover the cause, so that it can possibly be corrected.
http://www.bio.miami.edu/hare/ileus.html
http://rabbit.org/sluggish-motility-in-the-gastrointestinal-tract-2/
http://rabbit.org/disorders-of-the-cecum/

Is there any bloating?

 

[MyBunHenry]

The emergency vet did blood tests and said the levels indicated she was dehydrated so they started fluids. When I transferred her to the exotics vet she said the blood levels the ER vet faxed over looked good (except for the dehydration). She checked her teeth and said they looked good. There was one back tooth that was only slightly pointed but shouldn't have caused any problems. She had told me it was more than likely due to diet as I had gotten a little lax in making sure she was eating right (i.e. way too many treats and too much pellet food). Also, she is a little overweight (also my fault). Henry has always had access to fresh hay and water so that was good at least.

I just don't know if this is a normally slow process that will keep going back and forth until everything works out. I listened to her stomach and I can hear very quiet gurgling and movement. I don't know if I'm just being overly cautious and nervous. I've never had to deal with this in her 5 years with me.

Edit: As far as bloating, I'm not sure. Her abdomen doesn't look much different than normal and it's not hard. Anything really specific I should be looking for?

 

[JBun]

You would be able to tell if there was bloating. The abdomen would be hard and distended.

When my bun had stasis, it kind of went back and forth. He started to poop and eat the second day, but the next day he was back to not eating or pooping. Then two days later he was eating and pooping again. Then he gradually improved from there. But it took two weeks before he was eating and pooping normally. So yes, the recovery can be gradual and take some time. But if something doesn't seem right to you and you are concerned, her condition deteriorates, she stops swallowing, or just doesn't seem to be improving, you should get her back to the vet. Xrays would probably be needed at this point as well.

If she gets better, is pooping and acting normally but still won't eat on her own well, it's possible that dental spur is causing a problem, and you'll need to have a dental done.

 

[MyBunHenry]

She's definitely still swallowing as I am feeding her ~10 mls of critical care every 2-3 hours. She hates it and is definitely shying away from eating it but she does swallow it. She has fresh greens, hay, and water right now and I'm keeping her room as dark and quiet as I can. Have you tried pedialyte and was it helpful? I was considering giving it a try. I don't want to overdo it and stress her out but I'm just nervous.

And thank you for your help/advice!

 

[Orchid]

I can't offer any advice but just wanted to send you out some well wishes. I hope everything turns around for you and your Henry.

 

[MyBunHenry]

I can't offer any advice but just wanted to send you out some well wishes. I hope everything turns around for you and your Henry.

Why thank you!! She ate a few pieces of romaine lettuce and I gave her some gas drops and critical control. After all that she is officially angry at me. She started ripping apart newspaper that I have under her blanket. She's certainly feeling sassy.

 

[JBun]

Pedialyte can be helpful when a rabbit is initially dehydrated, but now that you are feeding critical care, there's no need, as it has all the necessary nutrients.

Feeling sassy is good

 

[MyBunHenry]

This is day 5-6 of Henry's stasis and I'm not seeing much improvement. Unfortunately it's a level 3 snow emergency so her vets office is closed and it is actually illegal to be on the roads.

Right now she is doing a lot of laying down or sitting up but nothing more than that. If I move her she will hop back to the spot she was laying down at. She had a day where she did pass a decent amount of feces but it has been days since then and the fecal output is very low. Sometimes nothing at all. I'm still giving her critical care and all of her meds. She will eat romaine lettuce or spring mix but only if I hand feed her and only a few pieces. She will not take it on her own. I'm getting very very worried. She doesn't seem to be bloated but I would have no idea what that feels like. I don't know if I'm being overly concerned or if this really will take a while to move past. I palpated her abdomen but again I wouldn't have much of an idea if anything is odd. I do hear some very soft tummy sounds happening in her gut when I pressed my ear to it.

Am I crazy? I just wish I knew what kind of things were a sign of "recovery". Her eyes are open, breathing is normal, eyelids are pink, mouth and tongue are pink, and her temp is 102 F.

 

[MyBunHenry]

I attached some photos to see if that can provide perspective? I have no idea. I'm lost. :sigh::sosad

Her eyes seem closed in the first one because my flash bothered her.

 

[lovelops]

I found this from U of Miami and thought I would post it. Maybe there is something in here to help you with Henry.

Read past can it be treated ...

Vanessa


Can GI Stasis Be Successfully Treated?
If your vet has determined that there is no intestinal obstruction, there are several treatments s/he may wish to use to help your bunny in distress. As always, do not perform any of these procedures or try to administer any of these medications without the supervision of a veterinarian experienced with rabbit disorders and treatments.
I. Mechanical Treatments
A. Abdominal massage.

• One of the single most effective ways to stimulate a lazy gut into action is with gentle massage. Place the bunny on a secure countertop on a towel (or in your lap, if the bunny feels secure there), making sure he can't jump down and hurt himself. With your hands and fingertips, gently massage the abdomen. Knead as deeply as the bunny will allow, but back off immediately if he expresses pain. We have found that gently lifting the rabbit's hindquarters a few inches (with the bunny's head safely tucked into the massager's elbow, and the spine firmly supported) helps gas to pass more easily, and seems to be comforting to the bunny. Once s/he gets over the initial surprise of being held this way, a rabbit will often allow his/her legs to droop in comfort and relief as the massage helps gas pockets move towards the exit. A rabbit's internal organs are very delicate; care must be taken to avoid bruising them and making the situation worse. After a bit of manual massage, try an electric vibrating massager. This seems to be as effective as manual massage, and it's worthwhile to invest in some type of massager with a large, flat surface that can be held against the bunny's tummy for relatively long periods. Press the massager firmly against the abdomen, start on low and work your way higher. The bunny may be a bit taken aback at first, but almost every bunny on whom we've tried massage has settled down and enjoyed the soothing vibrations. In addition to stimulating the muscles, the massage seems to help break up gas bubbles and ease colic. Massage as long and as often as the bunny will allow and enjoy.

B. Simethicone

• (liquid, pediatric suspension or tablets) is essential for the relief of gas pain which usually accompanies ileus. For relief of acute gas pain, 1-2 cc (20mg/ml suspension) can be given as often as every hour for three doses, then 1 cc every three to eight hours. This substance has no known drug interactions, is not absorbed through the intestinal lining and acts only on a mechanical principle: it changes the surface tension of the frothy gas bubbles in the gut, joining them into larger, easier-to-pass bubbles. Simethicone is practically inert, and is safe to give, even as a precaution, as long as it is not given long term. (Note: liquid suspensions of simethicone are relatively expensive. Less expensive versions, such as 125mg gel capsules are equally effective. A bunny can safely receive the contents of half a capsule at the rate described above.) A flatulent bunny is a happy bunny!

C. Monitoring Body Temperature.

• Of utmost importance is careful monitoring of body temperature via (plastic, unbreakable) rectal thermometer. Normal rabbit body temperature ranges from about 101o - 103o F. A higher temperature may indicate either stress or an infection, the latter requiring immediate veterinary attention. A temperature lower than 101oF is of even greater concern than a mildly elevated temperature. Abnormally low body temperature (hypothermia) may indicate shock or septicemia, a bacterial infection that has entered the bloodstream. A rabbit with a temperature lower than 100o F should be considered an extreme emergency. Pack the rabbit with warm water bottles wrapped in towels and get him to your rabbit-savvy veterinarian immediately. Medications often will not be effective when given to a rabbit suffering from hypothermia, so the first step in saving your bunny's life is to get his body temperature back into normal range. Warm water bottles and warmed subcutaneous fluids can be used to achieve this end, but it can take an hour or more if the bunny is severely hypothermic.

D. Enema.

• It may be helpful to administer an enema of warm, clean water mixed with a very small bit of unscented, laxative grade mineral oil. The addition of epsom salts to the enema liquid (at a rate of about 1 tablespoon per 30-40 cc's of water) may help draw fluid from surrounding tissues into the intestine, helping hydrate impacted matter. If you use epsom salts, however, you must be certain that the bunny is generally well hydrated with subcutaneous Lactated Ringer Solution so the reservoir of fluids in the bunny's body will not be depleted. Before you attempt to perform an enema on your rabbit, please ask your veterinarian to instruct you in this process during a regular office visit. Don't wait for an emergency to learn how to do this. If you cannot reach your vet when your bunny is in stasis, you will be out of luck!
  We administer the enema with a pediatric rubber ear bulb/syringe. A 5 lb rabbit can safely be given 10-15 cc's of liquid enema. Mix the water and oil well. Place the bunny on her back, well supported so she doesn't kick. Gently insert the lubricated tip of the syringe into the anus, no deeper than 1/2 - 3/4 inch. (Note: if you're not sure which orifice is the right one, the anus is the one that winks back at you when touched.) Be gentle. NEVER FORCE ANYTHING! Slowly empty the bulb and let the bunny remain on her back for at least 30 seconds, to allow the liquid to travel up the tract a bit. When you allow the bunny to flip back into normal position, gently lift her hindquarters a couple of inches (firmly supporting the spine!) so that the liquid travels up the GI tract. You may need to gently hold the anus closed to avoid a fountain.
  WE DO NOT RECOMMEND THAT A CATHETER BE USED TO DELIVER AN ENEMA. The rabbit's lower GI tract is extremely delicate and fragile, and it is distressingly easy to perforate the rectum or small intestine, with disatrous results. The ear syringe works well, and is far safer than inserting a catheter deep into the lower GI tract.
  An enema delivers liquid to the source. It can help hydrate hardened, dehydrated fecal matter in the lower GI, even when subcutaneously administered fluids don't seem to help. The very presence of the warm liquid also seems to stimulate the muscles of the lower GI tract.

E. Petroleum-based laxatives: use with caution.

• Laxative-grade mineral oil or commercial products such as Laxatone or Petromalt do not affect intestinal motility. Some veterinarians prescribe them in the hope that they might help to slide dry, impacted matter through the intestine more easily. Note, however, that if the intestinal contents are severely dehydrated and brick-hard (yes, we have seen this!), a coating of vaseline-like substance over them will merely impede their re-hydration and make it more difficult for the mass to break up and begin passing normally. For this reason, it is probably wise to concentrate on re-hydrating the intestinal contents before using petroleum-based laxatives, if they are to be used at all.
  Note also that whereas malt-flavored remedies in a tube are often preferred by the bunny, some vets believe that their higher viscosity may actually contribute to holding a mass of impacted food together, especially if the intestinal contents are dehydrated. Unscented, laxative grade mineral oil is less viscous, and may be more effective. Always administer such substances with care so that the bunny does not aspirate (inhale) any. Petroleum-based laxatives should not be given daily or long term, as they can impede the absorption of important, fat-soluble vitamins.

II. Non-prescription supportive measures
A. Oral fluids

• (normal fluid intake for a healthy mammal is approximately 90 - 100cc per kg--or about an ounce per pound--of body weight per day) are essential for hydrating intestinal contents that may have formed a hard mass and be nearly impossible to pass. Water is best, but unsweetened Pedialyte, an electrolyte drink designed for human infants (and available in the infant section of the grocery store), may also be used. Avoid any fluids containing large amounts of sugar (even Gatorade), as these can exacerbate the overgrowth of harmful bacteria in the cecum.

B. Force feeding.

• Anorexia can cause gastric ulcers and hepatic lipidosis (fatty liver disease) relatively rapidly in rabbits. Even 12 hours without eating is cause for concern. As long as your vet has determined that there is no actual blockage, and that there is enough slow movement of the GI to keep the stomach from becoming overly full, keep the bunny eating! An excellent, ready-to-mix emergency food for compromised rabbits is Critical Care, available from Oxbow Hay Company . However, if you do not have ready access to Critical Care, one quick and easy recipe is to soak about 2 - 3 tablespoons of pellets in about 1/2 cup of warm water or chamomile tea until they are soft and fluffy. The pellets will fluff more quickly in slightly warmed solution, but overheating may destroy some of the nutrient content of the pellets. Mix the pellet fluff with additional water or tea, vegetable baby food or even with canned pumpkin until it forms a somewhat liquid paste with the consistency of pudding. Allow to cool before using a large-bore feeding syringe (available at most pharmacies) to deliver the goods. Insert the tip of the syringe into the space behind the incisors and squeeze gently sideways to avoid squirting food down the trachea (windpipe). Give only 1-2 cc at a time, allowing the bunny time to chew and swallow. Aspiration of food can be life threatening, so do this with great care!

C. Unlimited grass hay.

• Provide plenty of fresh grass hay, such as timothy. Even if the rabbit won't eat timothy, oat, brome or other grass hays, it is probably best to avoid offering alfalfa hay. Alfalfa is too high in protein and calcium to be a healthy part of the rabbit diet. It also is more likely to cause bloat, and more likely to harbor the parasitic fungi that produce potentially deadly mycotoxins than grass hays. For these reasons, we never feed alfalfa hay, even to healthy rabbits.

 

[lovelops]

Here is the rest of the article. It was too long to put together in the original post
Vanessa

D. Fresh, wet, leafy herbs.

• The fiber and moisture in fresh vegetables also will help stimulate the intestine. Kale is a good choice. If the rabbit refuses to eat, try fragrant, fresh herbs such as mint, basil, dill, cilantro, tarragon, sage, fennel, parsley and others. Sometimes it helps to nip off the ends of the stems and wave the fresh, juicy stems under the bunny's nose or even gently insert the stem into the corner of the bunny's mouth. You can even lightly pat the herbs against the bunny's face until she gets annoyed with you and grabs the offending sprig. Sometimes all it takes is a little taste to get the bunny nibbling. Try a variety until one of them gets the bunny to eat. You never know which herb will stimulate the appetite, so it's best to have a variety on hand.

E. Lactobacillus acidophilus

• is not normally a member of the rabbit's intestinal ecosystem, but we have noticed that a good dose of dried Lactobacillus powder (available at health food stores in powder or capsules) seems to help the rabbit survive the crisis until the intestine starts moving again. No one knows why (and some would disagree), but it seems to help. It certainly does not hurt. Use non-dairy powder--NOT yogurt. The milk sugars and carbohydrates in yogurt may promote growth of harmful bacteria. Probiotic pastes such as Benebac are available at feed stores, and also might be helpful. Products designed for horses are generally safe and possibly effective for rabbits.

F. Cecotropes

• Some veterinarians believe that cecotropes from a healthy rabbit, although difficult to obtain, can be used to re-establish normal cecal flora in a compromised rabbit. However, other veterinarians and experienced rabbit caretakers are of the opinion that administering cecotropes to a sick rabbit may do more harm than good for two reasons: (1) force feeding cecotropes is very stressful to a sick rabbit, since no one likes being force-fed someone else's poop and (2) even a known, healthy donor rabbit could harbor microorganisms in the cecotropes that could become pathogenic in an already compromised rabbit. Also, because the normal cecotrope is coated with mucus that protects the bacteria while they travelthrough the stomach, mashing the cecotropes into a pellet mush might well render them useless. Given time and the proper supportive care, your rabbit will be able to re-establish a healthy cecal flora on his own, without the stress of being force fed foreign cecotropes.
  However, if you and your vet absolutely insist on trying this, you can obtain cecotropes from a donor rabbit by diapering the donor, or briefly placing an E-collar on him/her during the late afternoon when cecotrophy usually occurs. Don't use the E-collar if the donor rabbit seems very stressed or upset by it. (You don't need two rabbits suffering from GI stasis!)

III. Prescription/veterinary treatments
A. An intestinal motility agent,

• such as cisapride (Propulsid) or metoclopramide (Reglan) will help get a static intestine moving again. Both of the aforementioned drugs are safe and effective for rabbits. Cisapride, a more recently developed drug, has fewer potential nervous system side effects with long term use than Reglan. We have used it long term (for several weeks at a time) without apparent adverse side effects. However, as with any drug, your veterinarian should be aware of any potential drug interactions between cisapride/metaclopramide and any other medications your rabbit may be taking. For example, narcotic painkillers should never be given with Reglan due to the potential for dangerous interaction between the two. It may take as long as two weeks on metaclopramide and/or cisapride before the intestine is fully motile again, and patience and careful nursing for the duration are essential. In severe cases of GI stasis, both drugs can be used simultaneously. Because they work on different areas of the digestive tract, they may have a synergistic effect.
  Conventional wisdom holds that if there is a possibility of an intestinal obstruction, these drugs should not be used. However, more and more rabbit-savvy veterinarians are noting that unless there is a problem with the pyloric valve or an acute and true blockage of the stomach, motility drugs generally do not make the problem worse. So far, there is no consensus on this aspect of the problem, and it will be up to your veterinarian (and you, as your bunny's health advocate) to determine the course that seems right for your bunny. Once again, it is imperative that you not take matters into your own hands. Have an experienced rabbit vet diagnose the problem and prescribe proper treatment!

B. Subcutaneous Fluid Therapy.

• Note that examining a rabbit's skin turgor (via "tenting" the skin) will often not give an accurate indication of the animal's hydration status. A more useful diagnostic procedure for rabbits is palpation of the intestinal tract, which will feel very "doughy" throughout if the rabbit is dehydrated. Because rabbits absorb large amounts of water into their tissues from the intestine to drive other bodily functions, a rabbit whose skin feels well-hydrated may still have an intestine packed with a dehydrated mass. Keeping the tissues well-hydrated via appropriate administration of subcutaneous Lactated Ringers Solution (LRS) under your vet's supervision will not only keep the bunny well hydrated, but will also ensure that the electrolytes are balanced and make the bunny feel better in general.A dehydrated rabbit will feel tired and ill, and may not have as much will to live as one who is well-hydrated. Rabbits in GI stasis tend to be unwilling to eat or drink, so it may be a good idea to administer subcutaneous fluids as a precaution, unless the rabbit has known kidney or heart malfunctions, or other problems that your vet will be able to determine that would contradict administration of subQ fluids.
  As with the enema described previously, you should be able to do this procedure at home. But do not wait for an emergency to learn how to do it. Have your vet teach you how to administer fluids during a regular office visit. It could save your bunny's life.

C. Cholestyramine (Questran)

• is a granular resin with a high affinity for negatively charged, hydrophobic compounds, such as those produced by Clostridium spiroformes as toxins. Cholestyramine is used in human medicine to reduce serum cholesterol, and so is readily available at most pharmacies. If the rabbit has mucus in the stool, there is a good chance that Clostridium bacteria are proliferating and producing dangerous exotoxins. Questran will absorb these and be passed out harmlessly in the feces. Questran should be suspended in a generous amount of liquid (1/2 teaspoon of powder in at least 20 cc of water) and administered orally: because of its hydrophilic properties, it can dehydrate intestinal contents if given with insufficient water. Questran does not affect the action of the intestine; it is not absorbed by the body. Rather, it works directly upon the contents of the gut. We believe this substance has helped save the lives of many rabbits suffering from a severely inflamed intestine simply by sequestering toxins and buying time while gut motility medications and other treatments get the intestine moving again. It is safe and effective, used as directed.

D. Enzymatic digestive aids

• can be helpful in loosening and softening an impacted mass of food and hair (which, we remind you, is usually a symptom, not the cause of the problem!). Proteolytic (protein-dissolving) enzymes may be of either plant or animal origin. Papain (found in papaya) and bromelain (found in pineapple) may help to break down mucus binding an obstruction, thus allowing it to slowly break up and pass. However, there is no evidence to suggest that these enzymes break down keratin, which is the main protein component of hair. Both papain and bromelain are available in powdered form at most health food stores, and should be reconstituted in water or Pedialyte shortly before use to ensure maximum potency. Papaya tablets are little more than a sugary treat: they contain very little active enzyme. Canned pineapple juice is useless, as it has been cooked, and its enzymes denatured and inactivated. Even fresh pineapple juice is not as desirable as powdered bromelain, since it is high in sugar, which is just about the last thing you want to add to a compromised rabbit's intestine! If a hair/food mass proves particularly stubborn, even after rehydration efforts and plant enzymes have been tried, your vet may wish to try a more powerful, animal-derived enzyme product such as Viokase, which contains pancreatic enzymes to break down proteins, amylases to break down indigestible carbohydrates and lipases to break down fats. Although these enzymes may be better than bromelain or papain at breaking down an obstruction composed of ingested matter, they should be used with great caution, as they can burn the esophagus and cause temporary (two or three days) discomfort in an already sick bunny. If Viokase is to be used, it may help to administer just enough pediatric simethicone or laxative grade mineral oil to coat the esophagus for a moment just before the enzyme solution is given.

E. Appetite stimulants.

• B-complex vitamins, administered orally or injected, or Periactin (cyproheptadine) can be used to stimulate appetite. The former not only help stimulate appetite, but might also help supply what the bunny is missing by not producing or eating his cecotropes. Periactin is available in 4 mg tablets or a 1 mg/ml liquid suspension. An average-sized (4 - 6 lbs.) rabbit can be given 1mg by mouth, twice per day. It is vital to keep the bunny eating, even if you must force-feed. Anorexia can rapidly result in gastric ulcers and serious liver degeneration.

F. Antibiotics: Use with caution, if at all.

• Some vets routinely prescribe antibiotics for a rabbit suffering from GI stasis, either to combat the overgrowth of Clostridium spp. (metronidozole [Flagyl] is often used for this purpose) or to prevent secondary bacterial infection in the compromised rabbit (other rabbit-safe antibiotics such as the fluoroquinolones or sulfas might be used for this purpose.) While such cautionary measures may be taken, the practitioner should recall that unnecessary use of antibiotics is a prime reason that so many resistant strains of bacteria are evolving even as we speak. Unless the rabbit shows signs of bacterial infection (which can sometimes be the reason the intestine shut down in the first place), we urge a conservative approach: don't use antibiotics unless they are absolutely necessary.

IV. Pain Relief: The key to keeping the bunny fighting to live.
The importance of analgesia to a rabbit's recovery cannot be overstated. A rabbit suffering from GI stasis will sometimes just seem to give up and die, possibly because of the sometimes extreme abdominal pain. Although officially approved only for use in horses, flunixin meglumine (Banamine) is an excellent NSAID (non-steroidal anti-inflammatory drug) for use in rabbits. Although this drug can produce gastric ulcers in some species, substantial anecdotal evidence (involving many hundreds of rabbits over a period of many years) suggests that Banamine is tolerated well by rabbits, even when administered daily for several weeks. We have observed no adverse side effects from Banamine in our rabbits, some of whom have had to receive it daily for a week or longer.
Meloxicam (metacam) and Rimadyl (carprofen) are other NSAIDs which have been used with good results in rabbits.
Torbugesic, an opioid analgesic, provides good pain relief at relatively low doses. Although some practitioners fear that an opioid might contribue to GI slowdown, pain can certainly do the same. We have used opiods repeatedly in cases like this, with good results. We also have had success at relieving colic pain and inflammation of the intestinal lining with sulfasalazine, a combination sulfa antibiotic and NSAID compound. Sulfasalazine works topically to reduce intestinal inflammation.
Barium also may be useful as an intestinal "tonic" to relieve pain and help stimulate peristalsis, but its action is slow as compared to that of the aforementioned analgesics. As always, your veterinarian is the one best able to decide which type of pain relief is appropriate for your rabbit, given the specific conditions of his/her illness.

V. The Road to Recovery: Reduce Stress. ("If it ain't broke, don't fix it.")
It is essential that the caretaker faced with a rabbit in GI stasis be patient, allowing the treatments and medications to work. Rabbits are easily stressed, and excessive handling should be avoided. It may take several days before any fecal pellets are seen, and it may take two weeks or more of motility therapy before the intestine is moving normally again. We know of one case in which a rabbit produced no fecal pellets for 14 days, but finally did respond to gentle, consistent administration of the above treatment regimen. Patience and persistence are key.
Do not make more trips to the veterinarian's office with the rabbit than absolutely necessary (the stress of travel can slow recovery), but DO contact your veterinarian frequently to report on progress and any changes. Whenever possible, administer medications at home, where the rabbit feels safe and secure.
While you are treating your sick bunny, NEVER separate him/her from his/her bonded partner(s). The stress of separation itself can make the problem worse. We have known bunnies who seemed at death's door to recover when they were provided with the love and constant attention of their bonded mate. If your bunny does not have a mate, it is even more important that you, his best friend, show him a great deal of calm attention and affection during his ordeal. Rabbits seem to understand when they are being fussed over, and it may help them recover more quickly to know that they are not being abandoned in their misery. But do this within reason. Many a rabbit can sense a caregiver's fear for his safety, and this in itself can cause stress. Visit and love your bunny, but also give him time to himself to recover.
Every bunny parent should have a stethoscope (not necessarily an expensive one) to monitor intestinal sounds. The gradual return of gentle gurgling is a very good sign: once this begins, the rabbit is on the road to recovery, even if fecal pellets don't begin pouring out the chute. Administration of intestinal motility agents, gentle massage and supportive care as recounted above should be continued, and gradually tapered as fecal pellets slowly begin to come through the system.
Do not be alarmed if the first batch of fecal pellets is small, hard and misshapen, and even accompanied by some mucus. This is to be expected. Also do not be surprised if the rabbit produces a small bunch of pellets, nothing for a day, and then a bit more. The intestine sometimes seems to regain its function in fits and starts, rather than all at once. Consistent, gentle nursing and reduction of stress are essential at this time.
PLEASE RESIST THE TEMPTATION TO FORCE ADDITIONAL, AGGRESSIVE TREATMENT ONCE THE RABBIT BEGINS TO RECOVER. RECOVERY FROM GI STASIS IS SOMETIMES MADDENINGLY GRADUAL. [We know of one instance in which a rabbit was starting to produce fecal pellets and showing signs of recovery, but the veterinarian overseeing the case insisted on anesthetizing the rabbit to perform oral gavage, enemas with an extension tube and vigorous abdominal massage. Despite advice to the contrary, this veterinarian believed that the mass in the stomach could not possibly pass without such treatment. Tragically, the rabbit died. Necropsy revealed a ruptured liver. We cannot help but wonder whether excessive handling and the unnecessarily aggressive treatments contributed to, or even caused this rabbit's demise.]
VI. MOST IMPORTANT OF ALL: Backtracking to the Cause
Remember: Ileus is not an illness in and of itself. It is a SYMPTOM of an underlying disorder that has caused the bunny enough stress or pain to cause the GI tract to slow down or stop. Hence, ileus may be your first clue that something else is wrong that needs proper diagnosis and treatment. Once your bunny is recovering from the immediate GI stasis threat, it's time to look for the ultimate cause of the problem.

• Does your rabbit get insufficient fiber in her diet?
• Are you giving her too many starchy treats?
• Does she have an underlying infection or illness that's causing enough pain/stress to shut down her intestine?
• Does she have overgrown molars or an abscessed tooth? (NOTE: It is wise to check this possibility at the first sign of any change in your rabbit's eating habits. If your bunny has overgrown molars, this alone can cause an unwillingness to eat certain items, or even result in complete anorexia.)
• Have there been major changes in the household that are causing psychological stress to the bunny (loss of the bunny's bonded partner, a new pet in the house, visitors, construction, etc.)?

Any of the above could trigger an ileus event, and must be diagnosed and corrected if your bunny is not to suffer a chronic recurrence of the ileus problem. If your rabbit does not seem fully normal, even after the GI tract is moving well again, it's time to ask your vet to do some blood work, a deep oral exam (to check for molar problems), radiographs (don't forget the head!), a complete check of the urinary tract, and any diagnostics your rabbit-experienced veterinarian deems necessary to get to the root of the problem. DO NOT wait for an emergency to find a veterinarian who is experienced and good with rabbits. Unfortunately, many emergency clinics will not even see rabbits, let alone know how to properly care for one in acute distress. A veterinarian who treats a rabbit as if s/he were a dog or cat might do more harm than good. Plan now and avoid heartache later! Find a good rabbit vet in your area via the House Rabbit Society Veterinarian Listings.
VII. Prevention: The Best Medicine
The best cure for GI stasis is prevention. Be sure your rabbit companion gets plenty of dietary fiber from fresh grass hay. Feed high fiber (22% or higher crude fiber) pellets. Be sure your rabbit is drinking sufficient water to keep ingested food hydrated and moving smoothly. It helps to offer at least 4 cups of fresh, wet leafy greens per 5 lbs. of rabbit daily. And don't forget that regular exercise not only keeps the skeletal muscles strong: it also keeps the smooth muscles of the intestines well-toned and active.
Regular visits (including a molar check!) to your rabbit-experienced veterinarian will ensure that your bunny pal doesn't develop health problems that go undetected. Once such a problem becomes serious, it may manifest itself as GI stasis.
So here's to healthy peristalsis! May your home be blessed with great, big, healthy piles of gorgeous bunny poops. All in the litterbox, of course.



This article is dedicated to Alex, who died because no one attending him recognized the symptoms of ileus before it was too late. Alex, I wish I had known then what I know now. But your life and untimely passing inspired this article, which I hope will save the lives of other rabbits.



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

 

[MyBunHenry]

Thank you lovelops! I have read the article and have tried several of the things listed. She definitely does not like bunny massage but she didn't like it before either. She's actually pretty aggressive except right now that is. I just don't know if I need to relax and let time do its thing or if by now I should be seeing a relatively normal bunny.

 

[lovelops]

I'm going to throw this out also, and I know I posted this before and sound like a broken record but saw first hand what this drug did to my mother and it was horrible..

Vanessa

This is from the article above: Cisapride, a more recently developed drug, has fewer potential nervous system side effects with long term use than Reglan.

 

[MyBunHenry]

I'm going to throw this out also, and I know I posted this before and sound like a broken record but saw first hand what this drug did to my mother and it was horrible..

Vanessa

This is from the article above: Cisapride, a more recently developed drug, has fewer potential nervous system side effects with long term use than Reglan.

She's been on metoclopramide for about 5 days. She has enough for the rest of today and one dose tomorrow morning. After that I don't know what to do but I will ask the vet about the drugs listed. Thanks again!

 

[lovelops]

Thank you lovelops! I have read the article and have tried several of the things listed. She definitely does not like bunny massage but she didn't like it before either. She's actually pretty aggressive except right now that is. I just don't know if I need to relax and let time do its thing or if by now I should be seeing a relatively normal bunny.

It was pretty interesting especially on the wait and see area...
hopefully everything will work out and Henry will be out of the woods soon!

Vanessa

 

[JBun]

At this point you really should be noticing an upward trend of improvement. She should be feeling a little better and acting her usual self more often. She should also be eating more on her own, and you should be having to syringe feed a little less. If this isn't happening, it would probably be good to get her back to the vet as soon as it is possible, or at least call them as soon as you can to express your concerns. In the meantime, just continue with her care as best you can.

Just as a side note. Some rabbits can have problems with certain medications. They may have some sort of negative reaction and they may make them not feel well. So if you notice that your rabbit seems to be doing better and feeling good at certain points, and then consistently isn't feeling good after taking certain medications, then this may be an issue for her not improving. This isn't a common occurrence, but something I thought I would mention just in case.

I'm going to throw this out also, and I know I posted this before and sound like a broken record but saw first hand what this drug did to my mother and it was horrible..

Metaclop is regularly used in rabbits for GI stasis issues, without any problems(meaning, many rabbits seem to recover from stasis when certain medications are used, and don't when they are not). Since it is only used short term, these problems shouldn't be an issue, aside from the fact that rabbits have completely different digestive systems to people. Some medications that are ok for people would be deadly to rabbits. So you can't just say that if a medication is good for people it is good for rabbits, and vice versa. Just because a medication has caused problems for people, doesn't necessarily hold true for rabbits. Also you can't just substitute cisapride for metaclop in some cases. They both work on stimulating different portions of the rabbits digestive system. So it may be that one medication is being used for a particular purpose, to stimulate a certain part of the digestive system. Though one note, when taking your rabbit off of it, it's best to gradually decrease over a few days, as the rabbits digestive system needs time to get used to not having it.

Mybunhenry, if you are almost out of metaclop and there is no way to refill it at this point, so that you aren't suddenly taking your rabbit off of it, it might be a good idea to reduce the dose today, then reduce again tomorrow(unless she seems to worsen from first reducing the dose). This may also help it last an extra day at least, and will gradually get her off of it instead of suddenly, or at least help it last until you can get a refill from the vet.

 

[MyBunHenry]

At this point you really should be noticing an upward trend of improvement. She should be feeling a little better and acting her usual self more often. She should also be eating more on her own, and you should be having to syringe feed a little less. If this isn't happening, it would probably be good to get her back to the vet as soon as it is possible, or at least call them as soon as you can to express your concerns. In the meantime, just continue with her care as best you can.

That's what I kind of figured. :/ I keep nudging her around the house trying to get her to move and get her gut moving but she's not a huge fan.

Mybunhenry, if you are almost out of metaclop and there is no way to refill it at this point, so that you aren't suddenly taking your rabbit off of it, it might be a good idea to reduce the dose today, then reduce again tomorrow(unless she seems to worsen from first reducing the dose). This may also help it last an extra day at least, and will gradually get her off of it instead of suddenly, or at least help it last until you can get a refill from the vet.

This is her second refill already. She will run out tomorrow morning and I'll probably get another refill.

 

[lovelops]

jbun

I found this on the Tardive Dyskinesia site concerning reglan and animals:

Tardive Dyskinesia & Animals

Tardive dyskinesia is a side effect of a class of psychoactive prescription medications known as dopamine antagonists. One such medication is metoclopramide, often sold under the name Reglan. Side effects of this drug are rare in animals, but some that are predisposed to seizures may experience them more often. Other animals may experience drowsiness or hyperactivity. If you suspect your pet is having an adverse reaction to metoclopramide, discontinue the medication and inform your veterinarian.

 

[HyperRabbit01]

Maybe she's in pain due to the fact that she hops from wherever you move her and of course the sounds from the tummy. My rabbit had a similar situation where he would refuse to eat anything or even be as hyper as he usually is and I would give him strands of hay for him to grab the piece till he starts eating. I also gave him tummy rubs that did help him go through whatever he was going through (I would put a hand on his tummy and another hand on his butt/hindquarters for support and kind of 'bounce' him up and down and/or place both hands side-to-side and sway left and right). Also, if there's blockage try getting her started on papaya tablets and definitely cut down on the pellets.. I always give my guy a mountain of hay and enough pellets to cover just the base of the bowl, I never fill it up or anything like that because it would only make him fatter as well as treats obviously haha. I'm also a little careful about the veggies I give him because there's certain veggies that can contribute to the problem rather than help solve the problem.. whenever I give him veggies, it's a mixture of mint, cilantro and carrot tops. So my advice is to try what I tried and definitely have a ton of hay rather than pellets/treats. Hope I helped and your rabbit gets better!

Oh and definitely try to reduce stress too.. stress is an important factor when it comes to rabbits.