Toby in stasis?

[kirbyultra]

Toby: 9 month old neutered male dwarf/mini rex mix, approx 4 lbs.

Edit: He hasn't been outdoors. The areas he has been in recently have all been bunny proofed. He hasn't eaten anything odd except Kirby's fur, as you'll see below...

Let me give some background... Toby has been shedding his fur on and off for many weeks now and his poops are sometimes big, sometimes small. He eats like a monster and is a pretty good water drinker. I've never worried about him very much because his intake is so good that everything seems to work its way out of his system. I happened to give him some benebac 3 days ago because oftoo many days of consistent little round poops.On that same day, I swapped Kirby and Toby's litter boxes because I was preparing to try to bond them again. Tobydidn't like Kirby's box much but still pooped. However, the significance of this (in hindsight) is that he probably didn't eat as much hay starting then.

The next night, I gathered up my courage to do a bonding session for Kirby and Toby. Toby pulled his usual stunt of chasing Kirby around, and tearing out his fur whenever he made contact. I expected Kirby tobe the onewho'd be spooked for days after this event but it was Toby who took a behavior turn.Ever since that 15 minute bonding session was over, Toby hasn't been the same. Immediately that night, he was hiding in his box, refusing to come out. He ignored his greens that night, didn't eat much hay, but he ate some pumpkin (which had a bit of benebac)and still ate a little banana treat.

The next morning he pooped a little bit, but still hid in the box, refusing to come out to run. He didn't eat his pellets. With his own litter box back, he still hadn't eaten much hay.

I came home yesterday and found that he had not eaten any of his greens, touched only a few pellets, and didn't eat any hay, and he had pooped a few tiny, tiny poops that looked literally about this big: o He had also peed once. All of yesterday evening he nibbled on a couple of lettuce leaves, ate a few pieces of hay, a little bit of pellets and probably didn't drink any water. He took a few licks of the pumpkin with benebac in it. I figure since he wasn't eating the whole dose, I should continue to give him a little benebac in whatever pumpkin he was willing to eat. He finally pooped a 2 inch long cecal-looking poop that was strung together by fur, and another 1 inch poop that looked the same. That's when it hit me that Toby probably ATE a lot of the fur he bit off Kirby during the bonding. There were a lot of fur flying and clumps of Kirby's fur on the ground, but I didn't think Toby actually ate any until I saw his poop. After that, he got up and hopped around the house a little bit, but he didn't run and didn't play the way he usually does. Overnight he pooped more tiny ones and one really weird shaped mushy one that was bigger.

As of this morning still he hasn't eaten much hay, remainder of the pumpkin, or salad. I gave him a pineapple/water mixture yesterday and he didn't touch that or the plain water. Last night he was still responding to little treats (the oxbow freeze dried banana treats: I broke 1 chip into quarters, he had a total of about half a chip.). I'm not sure I should be giving him any more treats because of the sugar.

We're heading into Christmas and I just know that if I need to bring him to a vet, I need to do it today. I don't know if a vet would be able to help though with acase of stasis. I can't seem to get him to drink or intake anything with liquid in it besides a tiny bit of pumpkin. The only thing I can think of that might help is if a vet could give him fluids. I'm not sure what else to do. :tears2:

- Should I bring Toby tohis rabbit-savvyvet before I can't during Christmas and everything is closed?
- What else should I be doing to try to help him through this?
- Should I try to get him some pedialyte?

Please help me. I'm so scared for Toby.

 

[hln917]

Sorry to hear Toby isn't feeling well. Do you have any simethicone to give him? I would give him pedialyte. Perhaps thru a syringe if he isn't drinking on his own.
You may want to check with the Vet re: their hours to see if they'll be open Sat in case he doesn't improve. I know how I get when my buns are sick especially during the holidays. Another suggestions, get everything you may need today in case the stores are not open tomorrow.

I hope someone comes on and give you more suggestions/advice.

 

[ra7751]

If you don't have the capability of administering fluids, I would get to the vet today and get some fluids. Waiting until Saturday will probably just make matters worse. While oral hydration is better than nothing, it is so inefficient it usually doesn't work so well. Infusion by SQ, IV, IO or even IP will be much more effective. And hydration is what makes a good move.

Randy

 

[kirbyultra]

Thanks Randy. My husband is taking Toby to the vet at 11:30 today and we'll ask them to help hydrate him.

Helen: I don't think it's gas pain, his tummy isn't bloated or hard, I did not hear any gut noises --at all--, which is odd, I think. That's a good idea though, to hit the stores for anythig we need today rather than later.

 

[myheart]

ra7751 wrote:

If you don't have the capability of administering fluids, I would get to the vet today and get some fluids. Waiting until Saturday will probably just make matters worse. While oral hydration is better than nothing, it is so inefficient it usually doesn't work so well. Infusion by SQ, IV, IO or even IP will be much more effective. And hydration is what makes a good move.

Randy

Randy, I am getting the feeling that administering SubQ's should be a mandatory learned procedure for any pet owner. I would have never known what to do if it weren't for Luna, even though it is something I really don't ever want to do again. Is it best to keep a bag on-hand if one knows how to administer? How long arefluid bagsusually good for? Lines and needles should be okay for a long time if sealed...? Or is having this on-hand without ever needing itbeing too cautious?

We all know the worst events happen on the weekends and Holidays, I think pets have that stuff timed out... Better to be safe than sorry?

myheart

 

[hln917]

Janet-your right about the rabbits with their timing! Helen-if you need anything that you can't get out there since we know how the city is a ghosttown on the holidays, let me know. I can meet you at the border with it.

 

[ra7751]

I think everyone should know how to give fluids....and even more important, when to give fluids. Supplemental fluids are not appropriate in all situations....for example, head or internal trauma or congestive heart failure....but in a stasis situation, being able to get supplemental fluids in there quickly can be a life saver....or make the event much less dramatic. There are also different types of fluids....hypertonic, isotonic and hypertonic....basically it's the amounts of salts and minerals in the solutions....and that needs to be considered. While IV, IO or IP are the most efficient ways of adminstering fluids, those are not really ideal options for most people. IV has to go into a vein and that can be challenging with an alert rabbit. IO is very effective but the needle has to be inserted into the bone marrow. And IP goes directly into the stomach. For most of our purposes, sub-q is quite effective.

Most vets are quite willing to teach you and sell you the supplies. Most will teach you the clinical way of dripping the fluids. I do a much quicker way....I "push" the fluids with a large syringe and a butterfly catheter. For most rabbits, a 21g needle is best. You also need a scale to weigh your rabbit and be familiar with calculating amounts as hydration is usually done as a percentage of body weight. Any vet tech can teach you how to do sub-q fluids in a matter of minutes....it's not rocket science. An added benefit, once you learn to do these needles, you also know how to do injectable meds and that opens up many different avenues of drug possibilities.

The bags do have a shelf life. We do use donated fluids that are slightly out of date as long as they are not cloudy. If you use a sterile needle or line to pull the fluids, we use the bag for up to thirty days after tapping. Needles, lines and cathers are good and sterile as long as they have not been opened. We warm fluids to heat up animals that are hypothermic or in shock. Fluids open up all sorts of treatment possibilities. And I don't think you are overly cautious. I have a case of fluids, all sorts of needles and catheters and enough Heparin to float a battleship. Prepare for the worst and hope for the best.

I highly suggest learning how and when to administer fluids. Also keep in mind that administering fluids is the same in all animals so if you have a dog or cat that needs fluids, you can do it. I have done sub-q fluids on birds that weighed less than one half ounce. I always thought I could never do injections....now I inject everything I can and will pull the trigger on fluids at any hint of a problem.

Randy

 

[hln917]

How is Toby?

 

[kirbyultra]

I am happy to announce that Toby is looking much better but he is not out of the woods yet.

- 12pm came home from the vet after sub q fluids, metoclopramide injection
- 4pm gave him 0.5 mL of simethicone
- 6pm he pooped a bunch of ok looking ones
- 7:30pm he ate some veggies, and a little bit of pumpkin

The vet did give him sub Q fluids and also gave him a metocopramide injection (what is that?) He was feeling 10 times better by the time I got home. I am to give him cisapride 5mg/mL suspension (bottle says it's a stimulant - what's that?) at 0.2mL, 3 times a day until he eats, and simethicone 3x a day until he eats. She also gave him a pouch of critical care in case he refuses to eat. Since he is eating a little bit, I am not giving him critical care yet, just the meds. The vet told us he could have as much parsley as he'd like tonight as it's 75% water. He did eat a whole bunch of parsley. He nibbled on a few leaves of romaine, but did not eat his full course of salad by far.

He is now more active than he has been the last 2 days, so that is a plus.

The vet did not teach my husband how to administer sub q fluids, nor did we get anything of that sort to take home. I wasn't there to insist, so I guess that is our loss. I will be keeping a close eye on Toby's input and output just to make sure he's not dehydrated.

 

[kirbyultra]

We have a binky!!! Aw, looks like his mood is improving

 

[ra7751]

Umm.....metoclopramide and cisapride are GI stimulants. Those drugs will never be used with any of my rabbits. I, in my non-professional opinion, consider any vet that use these drugs in rabbits to be using out of date and unsafe treatments. These drugs induce very painful contractions in the GI. In the guts of dogs, cats and even humans....they usually work well. But there are numerous lawsuits regarding horrible side effects in humans caused by metoclopramide. Google that drug...interesting reading on reported and documented side effects of thisdrug. The idea is the induced contractions can literally force any impaction thru. In a rabbit, those motility drugs cause severe pain....and you know how rabbits respond to pain. GI events also lead to gastric ulcers caused by irritations and a rapidly changing pH. The ulcers cause an already thin intestinal wall to become even thinner. If a contraction happens near an ulcer, it can perforate the ulcer....and that is always bad. These drugs are a "win-win" for the vet. If the rabbit survives, the doctor is a hero. If it dies, you got the rabbit to them too late. No way for the vetto lose. None of my vets, all exotic focus specialists, will use gut stimulants in rabbits. Those of us that really know and understand how the gut works in a rabbit know the primary targets of response to stasis is hydration and resolving the cause of the stasis. And in my non-professional personal opinion...gut motility drugs will never, under any circumstances, be used on any of my rabbits and should be considered "off limits" for rabbits.

 

[kirbyultra]

That is really scary stuff, Randy. I'm glad I asked what they were. It was a curious thing to see how small the dosage was, now I see why it was used in small amounts. I gave him 0.2mL of cisapride at 10pm along with another 0.5mL of simethicone. He did poop again, normal size. He even nibbled more hay and some bits of romaine. He is bopping around, binkying, standing on hind legs and doing bunny 500s. My guess is that the stimulants were a "success" this time around, but reading what is out there, it's making me wonder about the vet's line of thought arriving at this treatment. Thing is, this vet is one of the national HRS recommended vets. This time it was the named vet herself seeing Toby, not someone else in her practice. I am not sure how to feel about this. I am however relieved that Toby is improving. Now that he is eating in small, increasing amounts, I am not inclined to give him anymore doses of cisapride.

 

[ra7751]

Most likely the true benefit was the fluids. I have had rabbits totally shut down for up to a week and responded primarily with fluids. Never a motility drug. Every one of them pulled thru. The thing when you get a blockage is that it starts pulling fluids from the walls of the intestines. That makes them stiff. The body knows what is happening and starts to attempt to move the gut by rehydrating....and it starts pulling the fluids from other organs. This seems to be primarily from the liver. We see a lot of wildlife die from organ failure caused by dehydration. To make an analogy of how the gut motility drugs affect a stiff gut....look at a piece of pasta. When it is dry (actually dehydrated), any pressure at all will break the piece of pasta. But when it is hydrated, it can move without breaking. Same thing happens in the gut. If you put a lot of pressure (induced contractions) in a stiff and dehydrated gut, something is going to break and when it does, it is always bad.

In your vet's defense, there is still an awful lot of publications that tout the "benefits" of these drugs. For those of us that truly understand the technical dynamics of the functions of the gut in a rabbit, we know the true horrors of these drugs. Vets receive very little training on rabbits and other exotic species in most vets schools....fortunately that is beginning the change. They base many of their treatments from dog/cat protocols......and we now know that many of the treatments that are common in dogs and cats can be harmful or fatal in rabbits. Metoclopramidealso is used for heartburn....which means it has toreduce acid in order to do that....and a rabbit's gut has to maintain an acidic environment or the beneficial bacteria will take a hit. It might be a good idea to discuss this with your vet and ask that they do some additional research on the technical dynamics in the gut and how these drugs affect a rabbit. As I mentioned, I have discussed my views on these drugs and none of my vets will use them in rabbits...period.

And again as I mentioned, just do a Google...especially on Metocloprmide.....and just look as some of the problems (in some cases really odd problems) that have been linked to these drugs.

But most likely all your rabbit needed was fluids...and fortunately the fluids absorbed into the gut before the drugs could start those painful and dangerous contractions.

Randy

 

[myheart]

Thanks for all of the information Randy. We always learn so much from you!!

I like your analogy to the pasta in terms of how the rabbit GI system reacts to motility drugs and fluids. Makes lots of sense... I wonder if that is how/why Naturestee little Sprite passed away. I know Naturestee has her suspicions about the motility drug that was used because it wasn't long after the drug was administered and poor little Sprite passed away with a bit of blood coming out of her bumm.She will never allow the the administration of a motility drug to her rabbits ever again. I do hopeNaturestee willcorrect meif I am wrong, but I think she would confirm what happened to her littlesweetie.

I really think this thread should get pinned to the Stasis thread in the Library so others will understand the importance of fluids and the affects of motility drugs in suspected stasis situations. Just a thought to keep the best information on hand for quick reference.

myheart

 

[NorthernAutumn]

Will pin!

How is Toby doing now, Helen?

 

[kirbyultra]

I'm so glad that my experience with Toby brought forth so much info. It's amazing how much I can learn from RO :highfive:And I am always so grateful for all the members and mods who care about our bunnies in a time of need. :hearts:

Toby is much better now, Autumn! He gave me a few binkies yesterday, and he's eating a lot more of his salad at each serving now. He doesn't eat all of it (like he used to) but he finishes it within each 12 hour period, which is when I'll give the buns another plate. His output is nice, round, and plentiful :biggrin2:

I am sure he'll be back to his old self 100% very soon.

 

[Maureen Las]

I'm very glad that Toby is better.

I spent Christmas Eve nursing Peewee who went into sudden stasis that night; I stayed uphalf the night and he was 50% better yesterday but not 100% there.

I used benebac , simethicone, tummy rubs, pineapple juice and pedialyte and kept the fluidsgoing in ; he is doing much better this evening , however the anxiety of this ruined my Christmas.

Randy'spastaanalogy to describe the effect of gut motility drugs on the dehydrated rabbit gut is really useful. I am keeping that one close in order to use it in future posts.
It really makes the concept understandable.

 

[tonyshuman]

Good to hear that Toby is fine! Sorry I wasn't on to help--they always seem to have emergencies on weekends and holidays, right?

 

[kirbyultra]

Toby is still recovering. I think he pooped the last of the bad ones last night. He has been going to his litter box a LOT! The color doesn't look quite normal yet but there is a lot. Last night he pooped big weird shaped ones that were like an inch long. Lots of fur stuck in it, solid. After that he ate almost all his greens in one sitting, back to his old self.

Kirby had a bout of gas on Thanksgiving. Toby went into stasis on Christmas Eve. These buns better not pull another stunt on me come New Year's!