Question about GI Stasis Episode

[Susanne]

Hi all, I was hoping to get some opinions on what could have caused the downward spiral Elmer went down yesterday/today.

First for background, I noticed Saturday night he refused his treat which has never happened. He seemed to start being normal and I thought he ate it a little later (in retrospect could have been Ruby). He was eating hay and hopping around normal. Next night also refused treat, but seemed ok so I went to bed. In the morning he was showing all the GI stasis symptoms. Hunched, not eating, grinding teeth. I got him to a vet in a couple hours. The vet took an x-ray and found some gas pockets, so gave gut mobility med, pain med, sub q fluid and Critical care. Sent us home.  By the evening he was worse. He wouldn’t eat CC (I syringe fed and he let it sit in his mouth) or move at all. I took him 2 hours to the nearest ER that was open. His gas had got so bad they had to do the gastro tube to get some out. They said otherwise he probably would have died. They said he’s doing well now so fingers crossed.

All that said- how did things get so bad? I of course want to avoid that kind of vet bill, stress, and pain in the future. I feel like both the vets I saw didn’t quite have all the rabbit facts right according to things I’ve read off HRS and some posts here. For example both said something about a hairball, where I’m pretty sure that is a symptom not a cause of the condition. Without yet digging into the trigger of the episode, my biggest question is about the body temp the first vet observed. It was like 98. something I’m pretty sure (have to call back and confirm). They said it was a little low, and at one point I asked about warming him up and the tech said he could die if I overheat him. Now I’m reading he was hypothermic and that is an “extreme emergency”. Could that have been why the treatment didn’t work? I have a few exotic vets somewhat close and if this one caused me additional 3,000 in vet bills I will need to switch.

[Bam]

I’m sorry this happened to you and your bun. Without a doubt you saved him by taking him to the ER vet.

This could have started as a gut slowdown, causing a “hairball” to form and block up the intestine. Rabbits are normally capable of passing hair, they always get some hair in them when they groom themselves. If the gut slows down though, hair and food can clog the intestine and cause a blockage, especially if the bun doesn’t keep eating hay (=fiber) and drink water.

What causes a gut slowdown can be many things, some of which aren’t fully understood. It can start with dental discomfort so the bun cant chew its food properly or is inclined to abstain from food because chewing hurts. It can also start with a stressful event (doesnt have to be anything so dramatic that the human understands it even is a stressful event) that changes the gut pH slightly. This can cause some gas to form in the gut, the gas can cause the bun pain, and buns in pain tend to stop eating or eat a lot less than normal. This creates less gut movement, more gas forms and so on.

I have been sent home with stasis buns that came in with a lowered temp but were warmed up with warm fluids and/or a heating pad. The bun shouldn’t be sent home until the temp has normalised. I have always been told to provide the bun with a heating pad/warm water bottle placed so that the bun can choose to snuggle up to it or move away from the heat source.  Hypothermia is an early sign that the bun is going into (medical) shock.

Sometimes gut stasis is a sign that there is something really wrong with the bun -most illnesses in rabbits first overtly manifests as gut stasis. In many cases, the bun will be fine once the episode is over (although the bun can still need a few weeks of monitoring, meds and perhaps support-feeding).

I’d have the bun’s teeth looked over once he’s more stable. You can’t se rabbit molars without an otoscope, so you need a good rabbit vet to look at them. It is important that the vet is rabbit savvy, or they might not be able to properly assess the teeth. I’ve had that happen with a bun that later proved to have really bad teeth.

Early treatment when a bun presents with inappetence is very important. I always start with a few rounds of simethicone baby gasdrops, about 1 ml per hour for 3 hours. (If there’s no change for the better after 3-4 hours, gas drops are not likely to do any good). If the bun is OK with sitting in your lap with a light fleece blanket over its back, it’s an excellent way of warming the bun up with no risk of overheating. You can help the bun pass gas by elevating its rear end a little bit.

Here’s a nice video on how to help a bun with gas pain:

https://www.howcast.com/videos/514701-how-to-help-a-rabbit-with-gas-pain-pet-rabbits

 

[DanaNM]

It’s really hard to say, but the one time Bun Jovi went into stasis our vet (very rabbit savvy) suspected that ingesting too much hair was the issue in his case as well (he was molting, and when he finally started pooping again there was a lot of hair coming out).

I agree that the vet should have kept him until he stabilized, especially with such a low temp, so that sounds like an oversight on their part. I wonder if the technician was inexperienced?

With the gas building up it sounds like he may have even had bloat? Did they mention that at all? If the fur buildup was close to the stomach I can imagine that causing a much more severe progression than if it was lower in the intestine, because the stomach would just keep expanding, rather than putting pressure on the mass to move it along.

I also agree that early treatment is important, since refusing a treat can be a big red flag. If a bun still seems OK but is starting to throw off some alarm bells, I often will syringe some fluids and even a small amount of critical care as well (along with simethicone).

I do think it’s worth talking to the original vet about his progression and what might have happened.

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[Susanne]

Thank you both, it’s so great to have this resource. I thought he was perfectly healthy and still sort of in shock.

I agree with both and a learning on my part, I definitely will take action sooner when a treat is refused. Getting the gas drops in him earlier/ getting to vet sooner probably would have made a difference.

At this point the focus is on getting him better, but the original vet did already schedule an appointment to check his teeth under sedation and trim if needed next week. Although, the ER vet didn’t seem to think the teeth looked like the issue.

I think he maybe did have bloat.  He said the CC was still in his stomach. They didn’t use that word but sounds like it met the description by the time he got to ER.

I just got an update,  last I had hear after the tubing procedure his temp went back up and he started munching on hay. So that was a good sign. But now he has cecal dysbiosis but not sure if it was caused by the stasis or the stasis caused it. He said it may not resolve? So I guess we aren’t in the clear yet. Also some of his bloodwork raised a flag about his kidneys, so they will have to check again after more treatments.

The ER vet also thought the original vet were OK to let me home with him at the low temp, but of course they want to be careful what they say I’m sure… but I am thinking about using my old vet again. Overall, I’m sure each case is different and it’s a tough call. I think I should have called sooner too as the day went on and he wasn’t improving.

I appreciate all the insights here, it helps to hear from long time rabbit owners that have been through some of these things.

[Susanne]

And @Bam thanks for the video. I actually found it yesterday when I was trying to research what to do (after it was too late). Elmer is a very difficult to handle bun and absolutely hates me holding him, but just need to do it next time.

[DanaNM]

Poor Elmer 🙁

It’s really hard to say whether the new symptoms are a side effect of the stasis, or indication of an underlying issue that caused the stasis. As you know stasis can be a symptom, and often more serious issues present like stasis at first and then progress rapidly. Things like liver torsion or a looped gut can also present like stasis and cause extreme pain very suddenly.

In any case, I definitely think you saved him by taking him to the ER, and it’s good that he is still under vet care. Hopefully he keeps recovering and eating!

(((Vibes for Elmer)))

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[Susanne]

Thank you for the vibes! It’s so hard knowing he had to ride in the car for 2 hours in all that pain, but so glad I decided to take him. I’m also sad for his partner Ruby. I couldn’t take her there so she is here alone and confused right now.

Hopefully in the hospital they can find some answers, otherwise will have to do some follow ups to rule out underlying issues that could have caused the episode. My guess is the Cecal Dysbiosis was from the stasis, only because he is such a good hay eater and seemingly good diet. I did switch from Oxbow to Sherwood pellets about a month ago, and they’ve been eating the softer 3rd cut hay for the last several months.. but that doesn’t seem to be a big enough deal to set this off.

 

 

[DanaNM]

Yeah with the diet change being a while ago I doubt that was it. How old is he?

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[Susanne]

According to the animal shelter records he’s now a little over 4.

I’m starting to think the kidney finding may be significant. He’s been drinking a lot of water lately. I also thought his pee had a sediment issue and was going to ask at his next check up. A couple random times he held his urine for over 24 hours. Once that happened like a year ago I called the vet but he finally went before I got him in.

[Bam]

It’s not uncommon for a rabbit to have very weird poop for some times after a bad bout of GI trouble, and your bun obviously has had a bad bout of GI trouble. It does sound like your bun had bloat. Bloat is often caused by a blockage near the stomach outlet, as Dana mentioned.

Sometimes a bun that doesnt like being touched will accept it when he’s poorly. My bridge bun Bam would normally be very cross if I tried to touch his belly -but when he had gas pain, he seemed to really appreciate a light tummy massage like in the Howcast video. That said, massage must never be performed on a bun that has suspected bloat. And if the bun hates being handled, it can be too stressful if you force yourself on him. As always, it’s you who know your bun best.

I hope you’ll get some good answers and that Elmer has a swift recovery. There are meds that can help with kidney function in rabbits.

We’d (obviously!) be very happy for updates.

 

 

 

 

[Susanne]

I got a call they were pleased and sounded like he was in the clear. 5 min later they called back that he crashed and doing CPR. It was over at that point though. He’s gone 🙁

[Bam]

I’m so, so sorry.

You could not have done more. Giving him simethicone gas drops etc when he first refused to take a treat would not have made a difference in his case. (Gas drops is just something to start with, really, but it definitely won’t fix anything if there’s a bad underlying cause).

I hope the vets can give you some insights into what this really was about, for your peace of mind. The kidney finding was probably central in this.

Again, I’m so sorry for your loss, both for you and Ruby.

 

Binky free, Elmer.

 

 

 

 

[Susanne]

I appreciate kind words. I am still in shock but want to do a rainbow bridge post in his memory soon.

The ER vet is going to do a Necropsy so I hope they can find something. Either a blockage that caused bloat or some underlying issue that triggered stasis. It seemed so severe. Regardless, I am going to try not to “what if” too much on what could have been done differently by me, or the original vet.

I’m sad about the last day of pain, not being there with him, and Ruby and I losing him. We didn’t get enough time with him. RIP Elmer.

[LunaLove33]

I am so sorry for the loss of you sweet Elmer, you are in my prayers.

[Susanne]

Thank you.

I talked to the vet again, he said at the end there was liver torsion and toxic shock? I am not sure exact terminology but those 2 things caused the crash at the end. The conclusion was that he got a small obstruction that triggered things, but even getting to the vet that morning all the gas buildup, cecal dysbiosis issue was already escalating so quickly we weren’t able to keep up with it. If the first vet would have caught the obstruction and hospitalized who knows, but the ER vet did call and explain some things and how she could do things differently in the future. He said she didn’t do anything technically wrong and many vets don’t see various issues in rabbits often or at all, etc.

[Wick & Fable]

I’m sure it is unpleasant to gain insight on what caused an end, but I hope that having some more clear answers can help you during this time. I also hope that you are holding onto at least some forgiveness for yourself because you did everything a great owner should have done.

The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.

[DanaNM]

I’m so so sorry for your loss, what a shock 🙁

I’m glad you were able to get some answers, but I do agree with others that you did everything a great owner would have. I would have done the same things myself given the info you had at the time. It’s hard to know what came first in the cascade of issues he was having, but it sounds like a very complicated set of things to deal with.

Often times more serious issues present as common issues in rabbits, so the first step is to treat for the common cause, rather than jumping immediately to more invasive diagnostic procedures. It really feels so incredibly unfair to loose a young rabbit, we expect all of our bunnies to make it to 12, but we never really know what can go wrong with them.

I hope you and Ruby can be some comfort to each other.

(((Binky free Elmer)))

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[Bam]

💔

I’m glad you got some answers. You really did all that could be done.

 

[Susanne]

Thanks again all, the support really does help. My friends have been great but I’m sure they don’t quite understand my connection with a rabbit 🙂 Like everyone said, I think it’s impossible to know exactly what happened, and I need to make peace with that and that everyone tried their best. Hopefully the experience of learning more from a different vet will help my family vet with future patients. I know even though his life was cut short and does seem unfair, he was a very happy bunny.

I’m working from home and giving Ruby plenty of attention which is helping us both. She is less a person bunny than Elmer was, and really seemed to love having a companion, so once we get through the first couple weeks I will likely get her a new friend.

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