(Help !) Fluid therapy for my bunny

[barneypie]

Help !

I would really appreciate any members who can advise me on this situation:

My bunny ("Barney") has not been feeling well during the past week, showing signs of discomfort and loss of appetite, and the vet informed me today that the blood work which was done yesterday reveals a high toxin count in the kidneys, suggesting either kidney disease orsome degree of kidney failure, which is very difficult for me to come to terms with.

The vet is hoping for the current fluid therapy that Barney is undergoingto show some signs of progress, and mentioned that it may be necessary for me to continue the fluid therapy at home, if the situation warrants it,since Barney is almost nine years old (Dutch).

Can anyone tell me of their experience in dealing with this kind of situation ?

Any type of prognostic, diagnostic, and treatment advice will be most appreciated.

Thank you !

Barneypie

 

[Bo B Bunny]

I wish there was something I could tell you. I know nothing really about this sort of thing. I am going to move this to the Infirmary tho to see if we can get a better response!

 

[Maureen Las]

It sounds like your vet hasn't yet determined the cause of the kidney problems (either disease or the ingestion of a toxin)and will need to continue to explore this.

I had a bun who developed acute renal failure at a very young age due to dehydration and starvation prior to rescue. Acute or sudden renal failure can often be treated if if recognized in time. It may be brought on by hypothermia, hyperthermia, extremes stress or fright, severe GI disease, plant toxins, mycotoxins, nephrotoxins, muscle damage (esp from a predator attack) or severe dehydration

Acute renal failure includes the symptoms of excessive urination, excessive drinking, failing to urinate, urine scald, loss of appetite, lethargy, dehydration and bad breath,
treatment includes subqutaneous fluids , anabolic steroids as an appetite stimulant, and antibiotics to prevent bacterial infections. Acute kidney failure can cause stomach ulcers which can be treated with sucralfate.

Chronic renal failure is often seen in older rabits, obese rabbits and rabbits with e-cuniculi, anorexia, cancer, cysts and urinary tract infections.
A blood test will verify suspected renal problems.
Chronic renal failure can be managed by giving fluids, and electrolytes, minimizing calcium intake (if the calcium level is high,) increasing potassium and restriciting phosphate

other drugs may be prescribed as well....

Since Barney is an older bun his renal problems could be related to the aging process but you do want to find the underlying cause if possible

it isn't that difficult to do subqutaneous fluids at home for your bun. The point of it is to help the failing kidneys flush out toxins that the kidneys themselves are unable to do. The bun feels sick bcause the toxins build up in the body and cause the bun to feel nauseted and leathargic

it is worth it to try to do subqutaneous fluids as your bun may not have severely damaged kidneys and may have good quality of life. It is also worth pursuing the cause of the problems.

In the case of my rabbit; Gabriel was so severely ill with a very poor quality of life thatI chose to have him PTS. he had total kidney failure
many people withrabbits animals (particularly cats) manage kidney disease with diet changes ,meds and sq fluids for lenghty periods of time with the animal still having good quality of life.

try to get a hold of the 2 kathy Smith books "Rabbit health in the 21st century and also"When your rabbit Needs Special care" : by Lucille Morre and kathy Smith.
Most of the above info are from thoses books.
here are some articles that may give you more information
I'm sorry that you and your bun are having these difficult problems.

Hopefully , Randy, a wild-life rehabber and infirmary mod will also post on this subject for youas he has a lot of experience dealing with rabbits and kidney disease.

http://www.rabbitsonline.net/view_topic.php?id=37848&forum_id=10
http://www.rabbitsonline.net/view_topic.php?id=12052&forum_id=10

http://www.rabbitsonline.net/view_topic.php?id=12158&forum_id=10

http://www.marvistavet.com/html/chronic_renal_failure.html

Good luck and have the best New Year that you can under the sircumstances

 

[ra7751]

Hi Barneypie,

Renal failure, as you know, is quite serious. Depending on the cause and degree of failure, it might be possible to treat the condition and offer a high quality of life for quite some time. I had a rabbit in renal failure for over 2 years and he enjoyed a high quality of life right up until the last few days.

I assume your vet has done a full CBC. Most vets are not aware of this one...but send a blood sample out to have a titer for E Cuniculi. This isa titer that all labsdo not have the capability of performing. What did the vet say the urine look like on a slide? Were x-rays taken of the lower abdominal? Was a cytology performed or maybe a full culture on the urine? If necessary, is you vet skilled at performing a procedure called "cystocentesis"? It sounds as if you are intending to find the cause and hopefully treat this condition. We need a full round of tests to determine what is going on and how to attack. Diagnosing is like a puzzle and each test is a part of the puzzle....and when the parts are all there and assembled, a correct diagnosis and treatment protocol can be determined. If you can get copies of any labs.....I would be happy to take a look at them along with my veterinary professionals that volunteer with my rescue....all my volunteer doctors are exotic specialists.

In the meantine, aggressive fluid therapy should be initiated. Depending on how the urine looks would determine which fluid I would use. In this case, most likely I would use Sodium Chloride. The vet will probably teach you how and when to administer sub-q fluids. They most often teach the "drip" infusion. I can teach you a much faster (and less stressful) method of administering fluids....it's a "push" that we use with wildlife. I would want Barney on some pain meds. Ideally, this would be a NSAID but that might be contraindicated with the possible hydration issues. So I would consider a narcotic aspect. In this case, Tramadol might be an ideal treatment. Most vets are not aware of using Tramadol in rabbits. It comes only in a tablet so it is most easily administered if it's compounded into a suspension. It can be flavored with FlavoRX to make it taste good. It can be used in conjunction with NSAIDs should the situation warrant. It is an excellent analgesic when given twice a day (BID in vet terms) but can also offer both pain management and a light degree of sedation when used three times a day (TID) if you need to "take the edge off" a particularly stressful moment. Valium can also be used to help with the stress of this problem. Your vet may also consider an injection of B Comp....it's a vitamin that helps stimulate the appetite and just generally makes them feel better. Make sure you are offering a proper diet. Wet leafy greens such as romaine lettuce can also assist with hydration....given in moderation of course. Letting him rest on a heating pad can also be very helpful. We use heating pads on all incoming wildlife.....and most people enjoy the benefits of heat with situations like this. You can cover a heating pad with a towel and put under a carrier. Have the heating pad under part of the carrier just in case he wants to move away from the heat. And supervise this since the pad can burn even on lowest setting. And the best therapy is all in the head....lots of one-on-one hands on TLC. Let him literally eat out of your hand. One of the only Oxbow products I will use is called Critical Care. It is a powder intended for hand feeding sick animals. I often make it into something like a paste and spread it on a piece of lettuce. I roll it up like a burrito and hand feed it. Some TLC. I also have used cranberry extract (available on line and at health food stores). Do not use cranberry juice (processed). I have also had some success in acidifying the gut with ascorbic acid....Vitamin C. This is a somewhat controversial topic but it does seem to help the renal system....and it also helps the gut......but it should be used in moderation. This treatment should also be weighed against any drug treatments that are used since gut pH will affect how some oral drugs are absorbed.

And in all honesty, as hard as it is, you must prepare yourself for what will eventually happen. Barney is in the autumn of hislife. With renal failure, especially if it's caused by pitting and scarring from E Cuniculi, will eventually get to the point that his quality of life will decline dramatically. It could come to the point that you will have to make a difficult decision. That decision will be the ultimate test of your love for Barney. I tell you this because I have been there. I was there with the namesake of our rescue. I had to make that decision. But Barney will let you know if it's time. As long as he is fighting this....eating , drinking, pooping and being responsive to you.....help him fight

This is just a brief over view of what is needed in a renal crisis. We need to isolate what exactly is going on and work up a treatment protocol. We need to know what is inhis urine. I am available to help you with any questions or even consult with your doctor should it be necessary. Healing vibes headed to Barney....and huge props to you for doing what it takes to help him. Also, if you could put your general location in your profile, or even send it to me in a PM, I have contacts with exotic focus specialists all over the US if the situation should escalate to that point.

Randy

 

[barneypie]

Randy,

You are absolutely AWESOME ! I am overwhelmed.

I'm going to print out your reply so I can show it to the vet who is working on this.

He's with the Avian and Exotic Animal Hospital in San Diego, CA -- have you heard of this practice ? The leading vet there, Dr. Jenkins, wrote the definitive book on G.I. Strasis, and Barney has been a regular patient there since 2006 (Barney had occasional G.I. Stasis problems, which the A.E.A.H. has always been able to correct).

These guys are excellent bunny experts, however, I have no idea if they have the vast array of knowledge that you have in this particular area.

I have already lined up a technician who can do house calls for me and assist with the fluid therapy, and syringe feeding or any other medical needs that Barney will be needing.

One question I have for you: Dr. Burgos (The vet who is handling Barney right now at the A.E.A.H.), mentioned to me the possibility of fluid therapy for home care when he told me of the blood test results yesterday, and he told me that the toxin levels were 5 times higher than what they should be.

However, he's hoping thatthe A.E.A.H.fluid therapy will have some good effect by tomorrow morning (Friday morning), and the technician I've lined up to help me with the home care fluid therapy feels that the toxin level will simply have to come down since the A.E.A.H. isconsistently flushing the kidneys even as I write this.

What is your take on that ? Can a Dutch bunny of 8.9 years have a good shot, with consistent fluid therapy, of bringing that rate (5X) of toxins down a bit ?

I first noticed this problem with Barney almost 2 weeks ago, but it was hard to discern if this was something other than another bout of G.I. Stasis, since that has been his only periodic problem over the past few years.

As he was still pooping (Though not as much, and smaller droppings) and stilleating, and had just been treated for a bout of G.I. Stasis a little over a month ago, I decided to watch him and see if anything else developed.

Since he then started to sit hunched up (Because of the toxins making him not feel well) in odd corners of the house, even though he was still eating (I would continually feed him kale and bok choy by hand, as well as Timothy pellets, apple, and banana), I decided to take him back to A.E.A.H., and they did the bloodwork on him just 2 days ago.

Whatever you can tell me will sure help.

I've got to read over your last reply a few more times just to digest it all.

You sure know your bunnies !

Very gratefully,

Barneypie

 

[barneypie]

Hi Angieluv,

Thank you very much for your reply. Yes ! Randy did reply, and what an overwhelming array of knowledge there is between the two of you -- I am extremely grateful (You have no idea).

I am reading and re-reading both of your replies, and in the process of digesting all of it, or as much of it as I can. I also have lined up a technician who can assist me with fluid therapy home care for Barney, and the hospital he is currently in has been giving him fluid therapy and is hoping for a reduction in the toxin level by tomorrow morning (Friday morning).

I asked Randy this question, so l'll ask you also: Is there a good chance, with consistent fluid therapy to flush the kidneys, and other therapies such as you and Randy mentioned, to bring that toxin level down ? The vet said it was 5 times what it should be after they did the bloodwork,but he then mentioned to me the home care fluid therapy as a possibility, and told me he's hoping to see their fluid therapy improve Barney's condition by tomorrow morning (Friday morning).

Barney is 8.9 years old, but I understand that Dutch bunnies can live exceptionally long, especially if they are happy. (I can't imagine any bunny being happier than Barney, though I'm absolutely sure I'm not the only one saying this about their bunny).

Any additio0nal info you can give me on this will be greatly appreciated.

You and Randy are great !

Very gratefully,

Barneypie

 

[barneypie]

Hi Bo B Bunny,

Thank you very much for moving this to the Infirmary section for me.

As you can see, I have had two excellent replies so far.

With much appreciation,

Barneypie

 

[ra7751]

If Barney is a patient at A&E in San Diego.....you have nothing to worry about. I have talked with Dr. Jenkins...aka Dr. Exotic.....on several occassions....most recently was several years ago as I was working different dosing on Zithromax. It was immediately apparent to me that he is one of those special doctors....and when you have a doctor like that, the staff at those clinics are usually head and shoulders above others. I would follow their instructions religiously. If anything can be done, you are in the place to get it done. I would give them the green light on anything they suggest.

And standard protocol in renal failure is to "flush" things out. That is the idea behind the mega dosing of fluids (but remember there can always be too much of a good thing) and acidifying the gut and renal system. That should dilute the toxins and bring the kidney values down. And I am sure they will investigate the cause. My gut feeling is either bladder sludge, spore damage from EC or a combination. I went thru bags of fluids with one of our renal failure buns. He was older and frail but the fluids would make an immediate difference in him....we told him he was getting "hi-test"....for those of you old enough to remember "hi test" gasoline. He lived a good quality of life for over 2 years in renal failure. Fluids are truly a life saver when used appropriately. I suspect the fluid therapy will help reduce the toxins.

If you are going to learn home fluid therapy (and I highly suggest it)....ask them to provide you with the supplies to "push" the fluids. It's just a faster way to get the fluids in rather than watching one drop at a time. It's less stressful on you and the animal. We use it all the time and it's really helpful when you have an animal, say a large hawk or eagle that doesn't understand we are trying to help, and it speeds the fluids along. I can administer a rather large amount of fluids in seconds. I use a large syringe (usually 60ml) with luer lock and use a 21g butterfly catheter. The flexible catheter allows some "wiggle" room and the syring allows you to force the fluids in quicker. It will only go in as fast as the needle will allow.....and the 21g seems to be just right.

Please keep me posted on Barney's progress. With the clinic you have, there is a huge learning potential for us all here. Live and learn. You are working with the best of the best!!

Randy

 

[barneypie]

Hello Randy,

YES ! YES ! Barney has been aCONSISTENT patient at A.E.A.H. since early 2006 -- both doctors, Dr. Jenkins and Dr. Burgos, as well as the entire staff, know EVERYTHING about Barney, andknowhim intimately !

During his bouts with G.I. Stasis, which was about twice a year, he was always there, even when he had to be hospitalized on a Saturday until the following Monday,as well as being a boardingbunny there when I've had to be out of town.

Dr. Jenkins told me about his own work with G.I. Stasis, and writing THE definitive book on the subject, and Dr. Burgos is just as awesome -- as delicate a bunny as Barney is, I won't dare go anywhere else -- it's a 3-hour drive for me everytime I take Barney there, but it's worth every mile of it !

Dr. Burgos recently worked on Barney's teeth, fixing the points, filing, etc., which helped him tremendously witheating.

I'm convinced that A.E.A.H. has the highest tech approach with the most cutting-edge, hi-tech equipment and procedures -- I've been to other good, so called "bunny specialist" vets, and they don't even come close ! In fact, one ofthe bunny specialistsin my area actually recommended A.E.A.H. to me 3 years ago -- his only option with Barney's G.I. Stasis problem at that time was possibly considering surgery -- whichcould have been absolutely devastating -- Barney was alreadygoing on6 years old then. Dr. Jenkins took one look at him and said "Barney's a LONG WAY away from surgery" -- and had him completely back on track by the weekend !

Since I didn't get a chance to really talk in depth with Dr. Burgos the other day, as well as heeding his suggestion that we wait until Friday (Tomorrow) to see what the toxin count is, that's why I logged onto this forum -- I'm very familiar with G.I. Stasis, but I know nothing about kidney problems, and that's why I was wondering about a toxin level in Barney that's 5 times the normal rate, and the likelihood of it being able to be brought down by regular fluid therapy, etc.

I'm glad you've dealt with Dr. Jenkins before -- I'll pass on your greetings to him and immediately keep you informed with what Dr. Burgos has to say tomorrow.

Randy, I really appreciate you taking the time to become involved with Barney's situation, and for giving me excellent advice in this forum. You've made it much easier for me to take a deep breath and keep calm in the current state of anxiety I've been in for the past 2 days.

Always grateful,

Barneypie

 

[ra7751]

Wow..you really understand what a real rabbit vet is. I am fortunate to live near a major vet school. Several of my vets are teaching professors in exotic focus. Several others are learning more and more....at my request. I have also been training them in wildlife protocols....and that has paid huge dividends both for me and my animals. And in turn, they have given me so much. I have access to things that most wildlife rehabbers don't even knowexists..and it's pretty much the same way with domestic exotics.It takes a very special vet to be willing to learn exotic and avian issues. It's not something that is given much time in vet school. Small animal is usually limited to dogs and cats, then you zoological focus, equine focus and farm animal focus. As the economy forces people to downsize housing, "pocket pets" are becoming more popular. The vet schools are finally responding with more focus on exotics, avian and wildlife. I often use my "special needs" rabbits to train vet students doing clinicals. My animals (all sorts of exotics and birds) present real world problems...not the generic stuff found in lab animals. Most vets have never even seen a real case of E Cuniculi....much less treated it. Many vet students have seen and examined myEC positive rabbits. They have also seen what happens when a serious ear infection is not properly treated...and the brain stem issues that can cause. And the list goes on. The labs can't provide that type of real world experiences. I have also been asked by the regional wildlife center to train vet students on advanced small mammal protocols at the vet school. That is a tremendous opportunity for me (especially considering I am not a vet) but it also will expose these students to some challenges they would not ordinarily experience. I have been preaching the values of finding and retaining a highly skilled rabbit vet....you are a testimonial to what I have been saying.

I am glad I could help in such a small way....it's made my night. But I really think the help you have at your fingertipsis far above anything I can suggest. You have something that so many don't have....a world class vet foryour rabbit. I know Barney will have the best of care...both at the clinic and at home.

Randy

 

[Flick]

I've made two videos explaining sub-q fluid techniques. One at a vet's office. The other (and more informative one, I think) is in my kitchen. No, that's not me giving the fluids. I'm strictly a behind-the-camera person.

[ame]http://www.youtube.com/watch?v=0wkSuUID2WA[/ame]

[ame]http://www.youtube.com/watch?v=10XODWMV3uI[/ame]

Best of luck to you and Barney. He couldn't be in better hands than yours.

 

[barneypie]

Hi Randy,

Thanks very much for the compliment -- I really appreciate it.

Remember, though, it is YOU who has made not only MY night, but my day as well, and kept me calm from the prior anxiety I've had over not knowing about kidney disease, toxins, E Cuniculi, etc.

I can't tell you how grateful I am.

Let's pray for Barney, and I know he will be fine.

I'll keep you posted.

Best,

Barneypie

 

[barneypie]

Hello Flick,

My my, grandma... what BIG EARS you have ! (Ha ha !)

(I love those bunny ears !)

Thanks for the offer on the videos. Theyshould be very helpful.

I'll keep you updated with what the vet says tomorrow.

Also, I appreciate what you said about Barney being in good hands.

Please pray for Barney --(God's hands are far morepowerful than mine).

With gratitude,

Barneypie

 

[barneypie]

Hi Randy,

Sorry for the delay in updating you -- this has not been a good day, and we did not get good news this morning.

Dr. Burgos said there was no change in the toxin level for Barney from a few days ago, and tomorrow I will be picking him up from the A.E.A.H. and bringing him home, and continuing the fluid therapy, and anything else that may help Barney at this stage.

I agree with you that Barney will fight to stay alive -- as you know, bunnies will attempt to become as well as possible, and look as well as possible, in order to avoid predators, and I have no doubt that he will respond to the love that will be surrounding him 24 hours a day.

There may be hope from an unusual source, besides healing from God, and I want your opinion on this:

I spoke to a friend tonight who has a cat that was in EXACTLY THE SAME SITUATION as Barney, diagnosed with irreversible kidney failure, and today the cat is alive and doing well (The diagnosis was over a year ago) because of a compound called Calcitriol.

He said the cat's toxin levels would not come down with the regular fluid therapy done to cleanse the kidneys (Same situation as Barney), yet small doses of Calcitriol ingested orally, taken along with the fluid therapy, completely turned the situation around.

Please give me your input on this.

I am not about to give up hope, as you can tell.

I will fight with Barney, as long as he has the will to fight, or until the indication from Barney is that it is his time to go.

Gratefully,

Barneypie