Update after seeing a specialist- advice needed

[henry2809]

Hi everyone! I posted a thread about a week ago because my 2.5 year old neutered male lionhead was having different sized fecal pellets. Well, on Friday he seemed to be feeling uncomfortable, so I took him to his primary vet. Everything looked normal on his exam, so she gave him some subcutaneous fluids and sent me home. He ended up passing a huge amount of mushy diarrhea/unformed cecotropes a few hours later. I contemplated taking him to the ER, but the closest ER that sees bunnies is 3 hours away. His poop returned to normal and he ate and pooped normally for the rest of the evening. On Saturday, everything was normal and his fecal pellets looked great. Last night, he passed more mushy stool/unformed cecotropes, but again, his stool quickly returned to normal once he had passed the mushy diarrhea. I took him to a specialist today and she performed an exam on him. She said that everything looked and felt very normal and healthy. She looked at a sample of his stool and did not find any pathogens, but she did find an overgrowth of yeast. Apparently, this type of yeast is a normal part of a rabbit’s GI flora, but he has an overgrowth. She recommended treating him with a course of nystatin, which is an antifungal. Does anybody have any experience with this or any advice or suggestions? I’m really worried about him.

[henry2809]

She also said that I could feed him some orchard hay to give him some variety, so I just bought an orchard/Timothy mix from Oxbow.

[Maria2022]

Hey, sorry you are going through this. My bunny Had GI issue which is called cecal dysbiosis(which developed after antibiotics use). My bunny stool also grew small amount of cyniclomyces gutttatus which is a normal yeast in bun’s GI tract. But specialist thought otherwise and wanted to treat it with nystatin but my bunny did not tolerate was having more liquidish stool. If yeast overgrows then I guess nystatin is the medicine for it. Now not a lot of vet use it or heard of nystatin. It is an antifungal drug, human uses it for oral thrush.

I read about bunny GI yeast growth in a literature and as far as i remember they recommend to give bunny hay and water only diet. Sugary diet can cause yeast overgrowth. So make sure you give plenty of hay and hay will help to push the yeast out of the system.

 

I am not a vet. So its just from my experience.

[Maria2022]

Also make sure bunny is having pain medication as well. Sometimes they will not show any sign but keep it handy

[henry2809]

Thank you so much! I’m going to try the antifungal to see how he does and I have Metacam on hand. Did your bunny end up recovering okay?

[Maria2022]

Unfortunately, my bunny passed away. We tried almost 2 months, but my bunny had a complex cecal dysbiosis issue. I feel he died because of pain suddenly. Just watch out for any unusual sign if your bun is having.

Most of the bunny recovers with appropriate diet, So do not worry.

[henry2809]

I’m so sorry to hear about your bun, and thank you for your advice. He is still eating and drinking wonderfully and his poops look great between flare-ups of mushy poop, so the specialist thinks he will be fine. I hope he is! I’m introducing some orchard grass hay with the Timothy that he already eats and he seems to like it!

[henry2809]

I’ve been emailing with his specialist and she really doesn’t seem too concerned at all since his fecal pellets are completely normal and healthy between his episodes of softer stool. Hopefully an increase in fiber from the new hay mix will help

[henry2809]

Alright, so I just picked up the liquid nystatin and he is supposed to get 1.8 ml every 12 hours for 10 days. He is pretty difficult to medicate and that’s a lot of medication, so we will see how this goes. My biggest fear ever is him aspirating from giving meds/baby gas drops/critical care. From what I have read online and other forums, it appears that cases of cecal dysbiosis can very often be corrected just by their diet (I am going to be cutting out ALL sugary treats and fruits for a few weeks). I’m going to continue feeding him pellets because I know that he won’t eat enough hay if I take away the pellets completely. I’m going to see how he does with the medication, but if it’s too stressful, I might just see if he can improve with just a stricter diet. I was emailing his specialist and she said that she was not worried and prognosis is great.

[DanaNM]

I’m not familiar with that medication, but it is discussed in this medirabbit article: http://www.medirabbit.com/EN/GI_diseases/Generalities/Enteritis_en.htm

I think adding a variety of grass hays is a good idea, and you are right that fiber is the name of the game.

How many pellets does he normally get? And how many treats and fruits does he normally get?  You maybe be able to slowly reduce them and increase his hay consumption.

In terms of giving medications and syringe feeding, go slowly and use a smaller syringe. Give them bun time to swallow after each bit. This is one of my fav videos showing how to syringe feed or give meds: https://www.youtube.com/watch?v=8iGZVYVm5Bg&list=PLn9xVcGXrVa5t-XUXErt_cTmjBPRKPnGZ&index=3&t=1s&ab_channel=petcareveterinary

You can also try mixing the medicine with a small bit of canned pumpin to see if he’ll take it willingly. Some meds taste sweet so the buns will just take them on their own.

. . . 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.  

[henry2809]

Thank you! I honestly think that I’m way more worried about this than I need to be, the specialist did not seem concerned at all and seemed to think that he would be good as new in no time!

Since I introduced the Orchard and Timothy mix a few hours ago, he has been LOVING it! I think he really likes the texture of the softer Orchard over the Timothy.
He usually gets about 1/4 cup of pellets per day, spaced out into smaller feedings during the day. I don’t really measure the treats, but I give him a few pieces in the morning and evening. I’m going to cut the treats out for a few weeks to see if eliminating that source of sugar helps. I’m hesitant to decrease his pellets because I’m doubtful that he will compensate for it with an increased consumption in hay (he lives for those pellets).
He just passed some small, mushy, mucousy fecal pellets, but that is a huge improvement from the unformed, wet diarrhea that he has last night. I honestly think that this could probably be fixed with just diet and the medication is just there to help the process along.
I’ve also been giving him 1 gram of BeneBac gel every day (I squeeze 1 gram between two little basil leaves so it’s like a BeneBac sandwich and he just eats the basil leaves and the BeneBac right up- that saves us both the stress of me having to administer it. I know the BeneBac may not be actually helping, but I assume it can’t hurt?

I just got home with the Nystatin (antifungal). I found another article that describes a rabbit with a similar overgrowth of yeast in the GI tract that made a full recovery after a course of Nystatin, so I figured it was worth a try. The specialist also said that it was essentially harmless because it doesn’t enter the bloodstream.
It is a large dose (1.8 ml twice per day), so I wanted to see if he would take it without me having to administer it with a syringe (to prevent him from getting stressed out). He loves the taste of the apple and banana flavored Critical Care, so I mixed about 1 tablespoon of Critical Care powder with the 1.8 ml of Nystatin and a bit of water to make a thick paste. I rolled the thick paste into a ball and he ate it right up. I basically made a “treat” out of the Critical Care powder and the medication. I know it’s probably a bit less precise than giving it to him with a syringe, but I figure this method will be best since I have to give it to him twice per day for 10 days and this will make it so that he just has to eat a little ball of Critical Care with the Nystatin mixed into it every morning and evening.
I’m really worried about him, but I think I’m doing everything right? Is there anything that you think I’m doing wrong or anything else that I could do? I’m worried about my little guy, but the specialist really didn’t seem too worried, or I’m sure she would have told me.

[LBJ10]

Is this the same rabbit from your other thread? I thought the concern was this small poops.

Yes, sometimes bunnies can recover from a yeast overgrowth with a “bland” diet (i.e. hay only). That being said, I don’t think the medication will hurt anything and it might help speed things along. Anti-fungals tend to not taste very good though, so I could see it being difficult to give. Sometimes vets will add flavoring syrup to medications, but sometimes it isn’t enough to cover up the yucky taste.

[henry2809]

Yes, this it the same bun! I think the poops were varying sizes because of the GI upset. I gave him the first dose tonight and I just hid it in a ball of critical care!

[DanaNM]

It sounds like he is on the mend! I agree it doesn’t hurt to try Benebac. And glad he likes the orchard hay!

1/4 cup of pellets is on the high end, depending on how much your bun weighs. Most buns do love pellets so much, but they are very high energy, so if they fill up on pellets they will eat less hay. You could cut back to 2 tablespoons and see if that helps as well. it may also help to only feed pellets once a day, to help the bun eat more hay during the rest of the day. My buns only get about a tablespoon of pellets each. 1/4 cup of pellets plus multiple treats each day could certainly contribute.

Also not sure what his veggies consist of, but some veggies have more starch or sugar than others, so that could contribute as well.

. . . 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.  

[Maria2022]

Hey, You already got wonderful advice above. You can read about intermittent cecal dysbiosis from here – https://rabbit.org/intermittent-soft-cecotropes-in-rabbits/

Good that your bunny is eating hay. I think you can take away all of his treats for now. Treats are never a good idea. Bunnies are ok with hay only diet. Now you can give him a good quality of pellets in moderation. plenty of water. It looks like you are on the good track. Sometimes, it takes months to get back a normal poop.

[henry2809]

Hey everyone! Thank you for all of the help and advice. Mickey seems to be doing well. His poops were normal all day Monday, Tuesday, and Wednesday. He had some excess cecotropes this evening that were mushy, but he had normal stool after that. I am still giving him the Nystatin and I do think it’s helping, I’m also giving him BeneBac as needed. Overall I feel like this is probably not something that I need to be overly concerned about since he is still eating great and his poops return to normal following an “episode” of the mushy/unformed stool.

[LBJ10]

That’s great! I’m glad he’s doing better.

 

[Maria2022]

It is a good news 🙂

[henry2809]

Alright everyone, I’m back with another update. There seems to be a daily pattern going on that I need to get to the bottom of. For the last week or so, Mickey barely poops from the hours of 8 am – 5 pm. He is acting fine, eating tons of hay, etc. but he seems very gassy and I can hear his stomach gurgling. He will sit in his litter box and lift his tail and act like he’s going to poop, but nothing comes out. Then around 5 pm, he passes a gigantic ball of cecotropes mixed with mushy stool. After he passes this “clump” of cecotropes, he is totally fine and poops perfectly overnight. This has happened for 3 days in a row and it’s almost exactly the same scenario every day. It’s almost as if the ball of cecotropes and mushy stool is “blocking” him up during the day and he can’t poop normally until he passes it. But once he passes it, he poops perfectly normal poops overnight and into the next morning. I have absolutely no idea what could be causing this. I have reduced his pellets and increased his hay and he has not had any treats or fruit for about a week now, so I don’t see how this could be a dietary issue. His specialist is reviewing his medical records and diagnostics from when he was seen at UGA in August, but she said that we can repeat the X-rays and do an abdominal ultrasound if I would like. Has anybody had a similar experience or have any advice?

[Maria2022]

Hey, sorry you are going through this. It sounds like your bunny is still having cecal dysbiosis issue. Has there been any parasitic investigation done, such as coccidia? One of my vet specialists said that if bunny gets persistent mushy poop they sometimes empirically treat them for coccidiosis. From my experience, cecal dysbiosis takes time to heal, it is an alteration of gut flora. Having said that, I guess the vet already ruled out other infections like UTIs.

Now if your bunny is not pooping well (during a certain period of the day) and it is a new issue, I guess the vet might consider giving him some motility drugs and pain medication. It’s extremely important that the bunny is stress-free and pain-free. Gurgling noise sometimes happens when they recovering from a GI issue.

Your diet looks ok though. What kind of pellet you are feeding to your bunny?

Also, do you have poop pic?

 

 

 

[henry2809]

Thanks for your reply. We sent a fecal sample to the lab and it was negative for parasites. He is currently still taking the Nystatin for a possible yeast overgrowth and it seemed to be helping at first, but not so much now. He is eating Oxbow Adult Timothy Hay pellets and a 50/50 mix of Timothy and Orchard grass hay. He is still eating completely normally and acting great, which I guess is a good sign. It almost seems like he has a plug of mucus and cecotropes and once he gets them out he resumes with normal poop. The specialist said that we could repeat x-rays (he had some done back in August when he was in stasis) so I will probably do that. I guess you’re right, if this is some type of cecal dysbiosis issue, it could take a while to heal, not just a week. My hope is that since he is still eating and acting fine and producing normal poop, that this is just an imbalance of some kind that will work itself out with a few more weeks on a restricted diet. My fear is that this is a problem with his anatomy that will not be able to be fixed. I do have lots of pictures of his poop but I can’t figure out how to upload them here. Every time I try it won’t let me.

[LBJ10]

Was megacolon ever mentioned?

[henry2809]

I mentioned it to the specialist but she said that she highly doubts that it’s megacolon since he is producing normal fecal pellets as well and he has had x rays done. She said that usually megacolon bunnies have chronically abnormal poops and his return to normal very quickly, so she is pretty sure that is not what he has.

[henry2809]

Any advice is welcome at this point because I am so worried. Do you guys think he’ll be okay?

[henry2809]

Im thinking about having the x rays repeated, but I’m worried about him being sedated for them. At this point, I’m just really really hoping that this isn’t a chronic issue or a problem with his GI anatomy and that it will be treatable.

[LBJ10]

That’s not entirely true. Sometimes it can start out as regular poops mixed with flare ups. I’m still leaning toward the cecal dysbiosis. You may have to go to hay only to see if that clears it up.

[henry2809]

I’m leaning towards cecal dysbiosis as well. I’m not sure if this is true, but I feel like if it were an actual abnormality or dysfunction with part of his GI tract, I would have known by now and something would have been abnormal on his initial x rays back in August. I’ve had him on this reduced pellets/no treat diet for about a week with not much change, could it take longer if it is cecal dysbiosis? In other words, could it still be cecal dysbiosis or is it likely a deeper problem since it hasn’t cleared up yet? I don’t know if this is accurate, but I feel like if it we’re an underlying issue or structural abnormality, it would have been found on the x rays in August and he wouldn’t be having normal poops and be eating and acting so well?

[henry2809]

So again, I just came home after being out for a few hours to a litter box of PERFECT poops and an active, binkying bunny. He’s eating wonderfully and playing with me. But again, tomorrow he will probably be gassy until he passes the big ball of cecotropes. This makes me think that maybe this isn’t a structural or underlying issue, it’s just overproduction of cecotropes that are effectively “blocking” the flow of normal fecal pellets?

[henry2809]

It’s very strange because during the day he seems like he is gassy and I can hear his stomach gurgling, so I have been giving him a dose of Benebac daily along with the Nystatin (anti-fungal). He acts totally fine during the day and eats tons of hay, but he will sit in his litter box and lift his tail as if he were going to poop and then he will turn around to check if there is anything there, but nothing comes out. This goes on for a few hours until he finally passes the huge amount of cecotropes and mushy stool that has built up and then he is totally fine after that and poops normally. I have not given him any treats or fruits for the past week and I really thought that would make a difference. Again, I really can’t tell if this is just a dybiosis issue that is causing him to overproduce cecotropes or if this is a problem with the anatomy of his GI tract. During his exam with the specialist, she said that everything felt totally normal and she did not feel any masses or anything at all. I am just so confused and worried.

[Maria2022]

Hey, Do not get stressed. I hope there is nothing wrong anatomy-wise. Have you seen any improvement yet in terms of reduction of the big mushy poop and more normal poop?

I think it’s taking time for him to get back to his normal flora. If you think he raises his tail and is in pain, a short-term low dose safe pain medication might be beneficial for your bun. You can also update your vet regarding your bun what’s going on. If your bunny is eating, drinking well, and still passing poop(a good amount), he should be ok.

FYI: If you see my other topic regarding my bun, there is a link where you can see my bun’s poop pic, which was cecal dysbiosis, now my bun had the issue after 2 different types of antibiotics and gut flora all died. In my experience, my bunny’s gurgling noise reduced significantly when he started eating hay only diet(no vegetables, no pellets).

[henry2809]

Thank you so much. I’ve seen a reduction in the mushy, unformed poop, but he’s still having excess cecotropes that seem to get “stuck.” I just felt like if it was an anatomical issue, it would be causing a lot more significant problems by now. Overnight, his poops are literally flawless. I’m still feeding him pellets, so many be I need to put him on a hay-only diet for a few days to see if that makes a difference at all. I also feel like the specialist would not have seen an overgrowth of yeast in his stool sample if it were an anatomical issue, it makes more sense that it would be cecal dysbiosis from something that he ate that threw off his microflora. They also did x-rays back in August at the teaching hospital, and I feel like they definitely would have noticed if there was something wrong with his anatomy at that point because they did so many diagnostics and he was there for 4 days. He is still super alert, playful, drinking, eating, and he is pooping a ton once he passes the “clump” of cecotropes. I just left him hay last night (no pellets) and I woke up to a perfect litter box full of poops. I feel like a hay-only diet may help to “reset” his GI tract. I wish there were a way for me to upload poop pictures to this forum, but it won’t let me.

[henry2809]

I’m not sure if this has anything to do with it, but I am now remembering that before I went on vacation (2-3 weeks ago) I gave him some banana and carrot, which he hasn’t had in a few months. Could that have been enough to throw things off and allow the yeast to overgrow and now he just needs some time on a bland diet to get things back to normal? I know that usually soma fruit won’t be enough to cause issues, but if he already has a sensitive stomach and I re-introduced those fruits, maybe it could have caused some upset?

[DanaNM]

Hmmm, the cycling does remind me a bit of what can happen with megacolon/cowpile/ cecal dysautonomia. But I also agree with your vet that having normal and healthy poops in between episodes doesn’t fit that diagnosis. Usually buns with megacolon never have healthy looking poops.

How is his weight? Weight loss (and specifically loss of muscle mass) is another key symptom of megacolon.

Does he seem gassy during the day? I wonder if you could add some simethicone and a few tummy rubs during the day, to see if that helps him get passed those episodes.

Some imaging during the day could also be informative, as you could see if the cecum is distended.

I’m not sure that those treats three weeks ago would still be causing issues, but some buns are super sensitive.

. . . 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.  

[henry2809]

After his exam last week, the specialist said that she really doesn’t feel like it’s dysautonomia or megacolon because most of the time his poops are absolutely perfect. She said that rabbits with those conditions usually have abnormal poops most of the time and their cecum feels strange on physical exam (which his did not) and his x-rays from back in August looked great, so she has essentially ruled those out because he doesn’t really fit the profile for a rabbit with those conditions. His weight has also not changed much at all. He weighed 4.6 back in August when he had stasis and he weighs a steady 4.1 now (but he is a healthy weight now, not underweight at all and his weight has remained very steady). I did just find something very interesting- I found a picture in my phone from the last week of November 2021 that looked IDENTICAL to what is happening now. The mushy excess cecotropes mixed with normal poops and once he passed the cecotropes, he was totally fine. That ended up resolving on its own back in November and it hasn’t happened again until now. My gut tells me that if this was something congenital/anatomical, it would not have improved and there would be other symptoms present (lack of appetite, lethargy, etc.) none of which he has. I didn’t give him pellets last night, just hay, and he seems to be doing a lot better today. Maybe he is just sensitive to his diet? I just feel like if this were a congenital thing, it would be pretty evident by now after seeing 3 general practitioners, going to UGA, and seeing a specialist. I think I am going to repeat the x-rays this week, but when she examined him last week she said that his cecum felt great, so that is somewhat reassuring to me. Even if he did by chance have one of those conditions, are they a death sentence or can they be managed?

[henry2809]

I also saw online that megacolon bunnies usually don’t produce cecotropes, which he is producing. He is also a brown lionhead, so I don’t think he matches the genetic profile of a rabbit with megacolon, but I could be wrong. I feel like he wouldn’t be acting so well if it were megacolon. He’s running around, playing, eating, drinking, etc. and everything else seems totally normal.

[henry2809]

At this point I am heavily leaning towards a dysbiosis/overgrowth of bacteria that just needs some more time to work itself out. He is acting awesome today and eating tons. He has had a few normal poops (not cecotropes) that are extra dark, mushy and watery but they are normal shape and size. They also smell quite stinky, so maybe that is the result of the imbalance in his gut. He is definitely normal on all other accounts and he seems much better today than he has in the last few days. I know you guys can’t diagnose him over a forum, but is it sounding more like a dysbiosis issue rather than a congenital/structural abnormality based off of his symptoms?

[DanaNM]

From what you described I think you are probably right, that it’s a more “simple” case of dysbiosis or excess cecotropes (and your vet sounds very knowledgeable).  Some rabbits are really sensitive to pellets, or even to a specific ingredient in pellets. Hay is really the best thing, and some bunnies even end up on a hay-only diet when they have really sensitive guts. If your vet supports it, going hay-only for several weeks could be a good next step.

Megacolon is something that does tend to shorten a rabbits life span, but it can be managed. Many rabbits with megacolon get daily cisapride to keep them from going into stasis.

. . . 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.  

[henry2809]

Thank you so much. I feel like that’s probably what it is since he’s totally okay otherwise. Hopefully finishing up the antifungal will help and he will return to normal soon, I am really worried about him. Since this happened a few months ago and it ended up resolving after a week or so, I’m hoping it just does the same thing again. Honestly I probably wouldn’t have even noticed if I weren’t so hyper vigilant and watched him all the time, so it’s probably not as big of a deal as I’m making it out to be.

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