(RIP) Sudden death

[Minerva]

Hi all. I am looking for some advice. I'll try to be as succinct as possible but it's kind of a long story.

Last week I booked two unaltered males (two of the ones I've taken in) to be neutered. One has always had what appear to be allergies and the vet decided that he wanted to put him on a week of baytril just in case before doing the neuter. I'd wanted to do this anyway as a precaution, so I agreed. The other one was neutered as planned.

Both came home doing well. The neutered male (sorry, I can't bear to mention his name yet) seemed quite alert considering. I placed his partner back in their pen and put him in the recovery cage alone. He ate immediately as well as drank, peed, and pooped. I was thrilled and felt that this would be a breeze. I checked on him periodically and he seemed fine. Before bed he seemed quite tired and I realized that I probably should have turned the light off a bit earlier so that he could get some rest.

The next morning he was very lethargic. His ears were a bit cool. I quickly made him a heating pad with rice and was wavering over what I ought to do when I saw him struggle as he tried to get up. That decided me; he was going back to the vet. As I stooped to sit him upright, however, he simply slumped over and was still. Just like that, he passed away. I was completely shocked and horrified. He was perfectly young and healthy and the thought of him dying never crossed my mind.

Now, of course, I am terrified to take his companion in to be neutered. I wanted to blame the vet of course, but when he called and talked to me he seemed not only very knowledgeable about rabbits, but also very caring about them.

I've summarized his responses to what I asked/mentioned in the next post for you guys to look over and offer your opinions on.

 

[Minerva]

What happened?
The procedure was very routine. He received a full checkup before and was in seemingly perfect health. He was put under anesthesia for a very brief period of time. The procedure itself lasted only five minutes. The vet prefers to keep rabbits under for as little time as possible due to their sensitivity to anesthesia. He was observed to be up, moving, and eating before leaving as well as responding to his companion.

The vet admitted that he had never seen this before. If a rabbit is going to have an adverse reaction to the anesthesia, it is usually the same day before they go home. He stated that he had had a couple pass away in recovery due to the anesthesia (simply not handling it well/ having a reaction), but never the next day. He seemed to ponder over this a bit because it definitely seemed like an issue with the anesthesia, but the time frame didn't fit.

He had looked over the file several times and made notes on what I told him, but the only other ideas he had were a continued drop in blood pressure or perhaps that coupled with a drop in body temperature, leading to hypothermia. It was around 75 degrees where he was but then I guess that probably wouldn't make a difference if his body temperature had tanked.


Which anesthetic was used?
He said he used ketamine, which is one of the safest for rabbits. I'm not sure if he said it was only ketamine or that paired with something else because the phone garbled as he said it. I'm assuming straight ketamine because it has the lowest time "under" from what I read and he likes to get them up again as soon as possible.


Was a painkiller used?
Yes; Buphrenorphine. The receptionist I talked to said that they did not give pain medication for this sort of thing (meaning spays and neuters, I guess) but he was VERY adamant to the contrary. He mentioned that rabbits are sensitive to pain and that he does not like to have them be in any pain, especially when coming out of anesthesia as it can inhibit them from eating. He mentioned that it is opiate-based and that he gives it as an injection coming out of surgery. It lasts for 24 hours and usually the males do not need more than that because the surgery is so minor. Females are given additional medications.

I also quizzed him on a few other things. The receptionist claimed that they did not spay females, but he said that he did. He mentioned that he had not been at that hospital long and that he had replaced the previous vet, who had retired. That vet did not do spays. He talked for a bit about how rabbits spays are more complicated and can be riskier because they are more invasive. He also knew that unspayed females ran the very high risk of uterine cancer. Another thing that the receptionist mentioned was that they did not see many rabbits, but he said that he saw quite a few and that the receptionists would too now as his patients followed him to the new center. He actually had another in when I talked to him.

So obviously he seems like he really knows his stuff. The logical part of me knows that he is probably the best rabbit vet around. The irrational part of me is certain that Percy will die too if I take him in.

I have called around to a few others of course. Some had questionable reviews and experiences online. One other has passed the test so far, but when I looked up the anesthetic he uses (sevoflurane) I found this in an abstract:

The effects of induction of anaesthesia with sevoflurane and isoflurane were studied in rabbits. All rabbits had periods of apnoea (ranging from 30-180 s) during induction which resulted in moderate hypercapnia and acidosis. Arterial pCO2 rose from 4.1 +/- 0.3 kPa to a peak of 7.6 +/- 0.4 kPa (mean +/- SD) (both agents). All animals showed a significant reduction in heart rate (P < 0.05). Heart rate (HR) fell from 226 +/- 33 to a minimum during induction of 57 +/- 32 (sevoflurane) and 199 +/- 41 to 45 +/- 11 (isoflurane). Most animals struggled violently during induction. Use of sevoflurane did not prevent the breath-holding response seen during induction of anaesthesia with other volatile anaesthetics in this species, and the severe apnoea which occurs may represent a significant hazard. The behaviour of the animals indicated that both sevoflurane and isoflurane are aversive, suggesting that this technique should be avoided whenever possible.

It seems far from ideal with those side effects, but of course that's just one source.

What would you do? Any thoughts or comments at all are appreciated, including on the veracity of anything that the vet said. I have no idea what I want to do at this point.

 

[Watermelons]

Hmm its hard to say, sounds almost like some type of acute infection... Something gone wrong internally vs the anesthetic. But cold ears says poor circulation. Possible clot? Possible issue with internal organs due to medication?

I don't like the idea of using Ketamine. Typically for more delicate animals we would use just Isoflurane. And given that its delivered via inhalation its mixed with oxygen which helps. Do you know if pre-meds were given or if this was straight ketamine? Ketamine STINGS LIKE A ***** and in a rabbit that has not been pre-meded their likely to seriously fight the injection of ketamine. Its often mixed with valium.

Male cats would get a pre-med, Injectable metacam, and then Ket-Val. No inhaled anesthetic.
Any other animal would get pre-med, injectable metacam, injectable anesthetic like propofol, then tubed and maintained under inhaled anesthetic (iso). These animals would also be on IV fluids for the duration of the procedure as it helps support their cardiovascular system.
The only animals that would get Buphrenorphine were ones that we amputated a limb, or did a FHO, or something seriously intense.

IMO a simple rabbit neuter doesn't need a narcotic for pain control either.

You've done your research for sure!
But theres a lot that this vet did that, that seems odd to me. But that's just the clinics I've been behind the scenes at. All are different.
But to me it sounds like internal complications.

 

[tonyshuman]

First, most vets now don't use sevofluorane but use isofluorane instead. That is a red flag to me. Most anesthetic drugs will cause a reduction in body temperature but if the animal isn't kept under for too long and is properly cared for during and after surgery (heating pads, etc), it shouldn't be an issue. I think buprenorphine is reasonable in this case because rabbit's don't tolerate pain as well and need to eat, so I differ in opinion from Watermelons on that one. It's also a bit longer-lasting than metacam.

I don't think the timeline fits with an anesthesia reaction as you mentioned. Sometimes animals react immediately after giving the meds, some pass away while waking up--probably within a couple of hours of the surgery. These kinds of reactions are probably less than 1% of animals that go through the surgery, however. It almost sounds like he was in shock when you saw him the next day. I wonder if he had uncontrolled bleeding after the surgery. Maybe an important vessel wasn't closed off properly, or came open again later when he moved around. Did you have a necropsy done? I would think that the vet office would want to do that.

I would look at our vet listings and/or those from the House Rabbit Society and find one that routinely does these things. I don't like that the vet and receptionist were telling you different things.

 

[Minerva]

First, let me say thank you VERY much to both of you for such thoughtful and detailed responses. I really appreciate it.

I don't like the idea of using Ketamine. Typically for more delicate animals we would use just Isoflurane. And given that its delivered via inhalation its mixed with oxygen which helps. Do you know if pre-meds were given or if this was straight ketamine? Ketamine STINGS LIKE A ***** and in a rabbit that has not been pre-meded their likely to seriously fight the injection of ketamine. Its often mixed with valium.

I'm sorry, I miss-typed that. I meant that the painkiller was given going into surgery, not coming out of it. I kept thinking about him coming out of surgery and put that instead. He mentioned that it was a pre-med, and that they also got an antibiotic. There might have been one more medication as well... I can't recall. He definitely mentioned that it stung when injected, which is why it was necessary to have a painkiller beforehand.

Sorry about that... he talked for 15 minutes straight and literally poured out medical information. I took some notes but he talked so much and so fast that it was hard to keep up.

Any other animal would get pre-med, injectable metacam, injectable anesthetic like propofol, then tubed and maintained under inhaled anesthetic (iso). These animals would also be on IV fluids for the duration of the procedure as it helps support their cardiovascular system.

I know that they didn't use an IV, but it was also mentioned that he was only under for 20 or 30 minutes. I'm not sure if that makes a difference or not.

The only animals that would get Buphrenorphine were ones that we amputated a limb, or did a FHO, or something seriously intense.

I think buprenorphine is reasonable in this case because rabbit's don't tolerate pain as well and need to eat, so I differ in opinion from Watermelons on that one. It's also a bit longer-lasting than metacam.

He did mention that he used the buphrenorphine because it did not seem to inhibit their eating and because it lasted longer. Around here lots of people either have rabbits out in hutches because it's an agricultural area or have them as pets but only ever take them in once to be neutered. There are lots of house rabbit owners too, but the others likely would not be bothered to administer medication of any sort. I'm guessing that's why he uses something longer lasting.

First, most vets now don't use sevofluorane but use isofluorane instead.

This is what made me leery of the second vet. I have never been to that office though. The vet my rabbits saw used ketamine.

I wonder if he had uncontrolled bleeding after the surgery. Maybe an important vessel wasn't closed off properly, or came open again later when he moved around. Did you have a necropsy done? I would think that the vet office would want to do that.

He mentioned and ruled out internal bleeding/hemorrhage. He said that he would suspect it during a spay, but he was positive that it was not possible in this case. I examined him and did not see any signs.

And no, I opted not to have a necropsy though I probably should have. I laid him on a folded sheet for Percy (his companion) to see. He ended up sitting by him for three hours, frequently grooming him and nudging him. I couldn't bear to have him cut open and cremated afterward. I also did not have anyone to drive me and did not feel up to driving myself.

I would look at our vet listings and/or those from the House Rabbit Society and find one that routinely does these things. I don't like that the vet and receptionist were telling you different things.

This was the first thing I did, rather than searching locally. Neither had any listings for my area in spite of it being a decent-sized city. When that turned up nothing I started calling places to ask.

Hmm its hard to say, sounds almost like some type of acute infection... Something gone wrong internally vs the anesthetic. But cold ears says poor circulation. Possible clot? Possible issue with internal organs due to medication?

A blood clot would make sense. Could this also cause the loss of motor control/coordination that I saw when he flailed around as he tried to rise? Like a stroke? However one thing that I forgot to mention to the vet is that his eyes were watery. Most of it was clear, but there was also a tiny amount of whitish goop in each one. I'm not sure what the significance of that might be.


Thank you again for your insight. If you have any other questions, ideas about what may have happened, or opinions about the vet I'm all ears. He gave me much more information than I could record. I just tried to pick what seemed most important.

 

[Watermelons]

Its honestly hard to say. (Sorry if what I typed made no sense... Me and the laptop don't get along)

A lot of what you said about that vets practices raise little flags in my mind. But that's from my own experiences and again vets are different no matter where you go.

Injectable metacam lasts 24 hours as well as the narcotic. One doesn't supress the system nearly as much as the other. However an overdose in a narcotic would re sult in signs directly after being administered, but what im thinking is maybe a reaction to the bodys ability to expel it? Liver? Kidneys? Too much for them to handle? But the pain killer wouldn't have helped with the ketamine injection. (Think of a big nasty cut, and just drenching it in 99% rubbing alcohol... but worse.) Not that this probably has anything to do with the death but its part of my... somethings not right here.... line of thought.

As per watery eyes, we would always use a lubricant type gel for the eyes on any animal that goes under. So if they did use something similar to that, that would explain watery eyes, if they didn't use a product, it could be that his eyes were extremely irritated from being so dry from going under that there was extra tear production.
Often when animals go under their eyes don't close all the way... Not WIDE open, but not totally shut, so think of staring at something for 30 mins straight with out blinking.

Very well could have been an embolis of some sort, be it a blood clot, or even an air bubble, in the brain or elsewhere in the body.

IMO because of what i'm used to. I wouldn't return to this vet. But that will hugely depend on what else you have available. The vet I currently use for my 2 turds isn't on any special list, yet shes done tons of bunny spays/neuters with no issue.
I would keep phoning the locals and ask them all your questions. Don't be afraid to try and trick the staff

 

[Minerva]

Thank you so much Watermelons. :hug2: That is why I have been so undecided. On one hand, the guy obviously knows and cares about rabbits. On the other, I would prefer to try someone else if there is anyone. So far, the only two that have met the criteria for the most part are the two that I mentioned.

I will say that everyone I have called has been very nice and patient with me grilling them. I have a questionnaire that I go through over the phone that includes how many rabbits they see, what type of anesthesia and painkillers they use, if they have reservations spaying/neutering small breeds, etc. Usually they have to write it down, interview the vet, and call me back. So far every single one has done so in a timely manner. And I do get quite tricky with them too!

As for the ketamine, both he and the receptionist I talked to mentioned a gas. I'm not sure what the name of it is, but after what you've said I'm guessing that the part that was garbled WAS the name of another drug after all. To be honest I hadn't the slightest clue how these things were administered until getting the crash course. I knew that ketamine was injected but assumed that it could also be given as a gas when they mentioned gas. After looking it up and having him mention an injection I thought I misunderstood about the gas, but if it hurts as badly as you say then it must have been both. He talked at length about the importance of rabbits not being in pain because they stress so badly; since he feels that way he obviously wouldn't go and put them in pain right before surgery. Guess I should have thought of that. I can ask him to clarify since I'm going to talk to him about the baytril tomorrow. He also mentioned a reversal but he can be hard to understand when he talks quickly.

Okay, after typing that I realized something else important that I left out. The vet I took them to is Indian and does have an accent, so he was born in India. I don't know whether he practiced there before coming here to go to school/become certified to practice/whatever, but if he did then I would imagine what he uses is what he is comfortable with, which is whatever was available there. I am glad that you made me think of that because it is definitely a factor as well, whether or not his techniques may be out-of-date or not ideal (it sounds like they may be).

Out of curiosity, if these two are the only suitable two which would you use? The second one (that uses sevofluorane) made sure to have the receptionist tell me that the surgeries would be "high risk" because of their small, 2-3 pound size. That makes me feel that he may not be confident with small breeds. The receptionist said that he does really well with rabbits and sees 2-4 a month, but only does spay/neuter and does not treat rabbits. I cannot decide how I feel about him. I really don't like the sound of the sevoflourane either.

I am going to continue calling around of course. Realistically there is no way I can call every single veterinary office in the city and ask if they see rabbits, but I'm going to try to find at least one more option.

Gosh, I didn't mean to make this so long again. Thank you again (both of you) for reading through all of this and lending your expertise. Your insight is invaluable. :hearts:

 

[curiouscarrot]

Minerva, I don't know about the vet particulars, but things happen without anyone having done anything wrong. My cousin found a kitten that I was going to adopt and he went in to get his ears done (mites) and shaved (all matted, was a persian) and he died. The vet was so upset and did an autopsy, said the only thing was his kidneys were a bit underdeveloped. It was probably because he'd been living rough that he couldn't support being anaesthestised. I've used that vet for 20 odd years since then. I don't blame him, I trust him. I bought a budgie as a friend for my budgie and it died overnight. I felt awful, but I know I didn't do anything wrong. I now have another and the two of them are just fine. A friend at work's mother went in for surgery and she died. There was no particular negligence on the part of the surgeon, no huge mistakes. Sometimes things happen, but they don't happen because somebody messed up. You are right to consider the competence of the vet and you might feel more comfortable going to somebody else, but I wouldn't worry too much about your other bunny having a poor outcome. They are sensitive and it can happen, but I think it would be terribly unlucky for the same thing to happen again. These bad things are exceptional.

 

[Watermelons]

I only picked on the ketamine because it just seemed fishy that they would take a fully alert rabbit and try to inject it. Ketamine is only for injection as far as I know. I'm hoping that vet used some type of oxygen & Anesthetic gas mixture, to help keep them under. Injecting ketamine to an animal that's not premeded is like asking for trouble if theres even residu on the tip of the needle. But you've all ready said that he used pre-med.

I wouldn't use the vet that's using Sev and says its high risk. That's like adding their own little insurance policy for them being scared about doing it. The vet needs to be confident in what their doing. Some vets will refuse to spay/neuter until 6-10 months because they don't like doing small rabbits. I had to convince mine to do my bucket heads at 3ish months because I refused to split them up and didn't want babies from a brother and sister.

Keep calling around, you may find a hidden gem.


How my guys were done, arrive together at vet. Receive injectable pre meds, which is usually some type of painkiller/sedative, so they look really nice and drunk, this takes time to take effect. Dependant on the animal and vets, some animals may just get masked down at this point (Wrapped in a towel and mask held to face so they can breathe in gas anesthetic, we would usually save this for nasty cats or the 8wk old kittens) Otherwise we hold up groggy animal, place IV catheter or use Injectable anesthetic, Propofol or Ketamine mix for the boy cats. If its not a rabbit or boy cat, the animal gets tubed. and gas anesthetic hooked to that. My guys Got their pre-meds, then got iv caths to maintain cardio vascular system as antesthetic supresses this. And they got masked down and maintained via just gas.

Not doing an injectable anesthetic like the propofol or ketamine wakes them up a little quicker so their more likely to go back to eating quicker.

This is a "Masked down" 1-2lb rabbit. Shes bundled in the towel receiving ISO & oxygen via the mask.

Maintained for the surgery itself by the inhaled gas anesthetic. Shes totally out but as you can see, eyes are partially open. iv fluids are running, and equipment is on to moniter Blood pressure and heart rate during surgery. Loki didn't get that part since he was done before they could get the probe taped in place.

 

[Spikethebunny]

I am not knowledgeable about the procedure as everyone above is, so I can't be helpful in that area. But I just wanted to say I am so sorry for your loss. And I hope everyone here is able to help you figure out what to so.

 

[Ilovemyrabbit]

I don't know anything about the procedure either, but I'm so so so sorry for your loss. I would be devistated if that happened to me.

 

[Zeroshero]

I am so sorry to hear of your loss, i would be devistated. Do you happen to use softwood litter in your rabbit boxes? I came across this article last week, it might be worth considering.

http://www.rabbit.org/care/shavings.html
http://www.rabbit.org/journal/1/liver-disease.html

 

[Nancy McClelland]

:yeahthat:We've been very lucky--had 14 different boys done and no problems. Same with the girls times 19. Only had to syringe feed one of the boys and he came right back to his old ways. We have had a couple of younger bunnies pass with no sign of anything though. It's like the old Johnny Cash song, "I don't like it, but I guess things happen that way".

 

[Azerane]

How many rabbits does the vet you saw see a month? You said the other vet saw 3-4 bunnies a month, which to me isn't very many. But how many does the one that did the operation saw?

In my opinion, judging by everything I have read so far, I would go back to the vet you just saw. Tell him all/any of your concerns about the way he did things last time and ask why he didn't use x instead of y for eg. I understand why you are hesitant and it is a terrifying thing, but I just don't see it happening twice. Best wishes for whichever way you choose.

 

[Minerva]

Watermelons, I really cannot thank you enough. On the contrary, I am glad that you picked about the ketamine because I was able to remember more details that I probably wouldn't have been able to. I was a mess when I talked to him and obviously had mixed some things up or forgotten them. I am also very grateful for your suggestions as to the possible causes. I know it could have been anything, but it is reassuring somehow to know some possible causes.

Spike, Elise, Zero, Nancy, and Azerane-
Thank you all very much for the condolences and reassurance. I have been struggling with this even though I know he was not at fault in any way, just because it was completely unexpected and it happened right in front of me. I had a hard time looking at the others afterward because it was just wrong that he was missing. I expected to have him for many years to come and I kept expecting to see him when I went in, or thinking that he would be coming back.

Nancy, that really is very comforting. I have been telling myself that it is very unusual and that the others will be fine, but it is hard to banish the negative thoughts.

Zero, I'm not sure what you mean. If you're asking if they are exposed to wood shavings then no, they aren't. I've never used wood shavings for anything.

Azerane, I agree that that did not seem to be many. I'm not sure how many the one I saw sees per month, but I know he saw four that week. He only sees them Wednesday through Friday, so that seems like a decent number. The receptionist said that he only allows the vet tech that is experienced with rabbits to care for them, so he sees them on the days that she is there.

If I cannot locate another, that is what I will do. I read some reviews on Vet #2 and found that many people said he was heartless, completely not compassionate, and did not care for the animals. The vet I went to definitely cared about his patients, which is worth something.


The good news is that I think I have at least one other option. I found my papers from back in March or whenever I was hunting down vets and noticed that I had written down information and pricing on one other place. I had totally forgotten about it. It is three times the cost of the others but that's not a problem. I wrote down "impatient/not knowledgeable" next to it and had eliminated it. I think I remember being really turned off by the attitude and complete lack of rabbit knowledge (she had to keep asking someone else) of the woman I spoke to. I will be giving them another call tomorrow to ask some more questions. I can deal with snotty receptionists as long as the vet is good and knows what the heck they are doing.

I also spent time after work tonight composing a list of "shot in the dark" places to call tomorrow. The problem isn't that there aren't enough places; it's that there are too many! There are tons and tons of veterinary clinics around here, and 97% of them are cat-and-dog. I just found a dozen on Yelp that I didn't know were right in my neighborhood.


Once again, a huge THANK YOU to everyone, especially Watermelons. :hearts: Wish me luck on my calls tomorrow. I'll post my findings. I'd love to have two more options, though I'd happily settle for one good one.