When are gut stimulants really needed?

Hi,

I was interested to hear your views on knowing when to give gut motility drugs such as metoclopramide and prepulsid to a rabbit when it is presenting with an attack of gas pain which has come on quite suddenly versus GI Stasis which happens more gradually and where you see more signs of gut slowing down, ie smaller droppings, rabbits starts to eat less & less.

For instance, I had a bunny who I've had to keep well syringe fed because of a dental that didn't go well, this bunny was producing regular droppings and I was keeping the gut functioning because I was making sure she was well fed because she wasn't eating enough on her own. However, after a syinge feed and a dose of oral metacam one afternoon, she became increasingly uncomfortable and I knew she had gas pain. I started her on infacol & kept her syringe fed till I got her to vets next morning. Indeed, vet noted gas (distension in stomach), he gave her sc fluids (40ml), metoclopramide injection, an anti-anxiety drug, zantec & oral metoclopramide & prepulsid to take home & administer till she improved. I should point out I told vet I didn't know if the metacam had contributed to the gas pain or not, but she did go downhill after a dose of it. (She has been on metacam daily following a dental). Also made sure vet knew she was being syringe fed (due to suspected mouth pain post dental) and that she was producing regular droppings.

I followed my vets instructions with the gut motility meds & zantec, but my rabbit did not improve, infact she seemed worse so I stopped all the vets treatments and pursued with regular doses of infacol (gentle tummy massages) & syringes food & water. She did pick up eventually, but not thanks to the treatment of my vet and she was miserable for a good while with this gas pain.

Therefore with this type of siuation where gas pain has come on suddenly and caught early, are these gut stimulants really necessary?? I felt she should have been given a painkiller, but she didn't get one and I feel the prepulsid and metoclopramide meds made the situation worse for her. I cannot understand why vets do not give rabbits pain relief to rabbits who present with gas pain straight away, surely this is of upmost importance and if rabbits are not given one, they are only going to get worse or delay any kind of improvement. I do appreciate that gut motility meds may need to be given when GI Stasis is happening and especially so if getting to an advanced stage, but again, pain relief in this situation has to be of the upmost importance surely??

Thoughts on this would be appreciated,

Thanks,


Sue

I too get most frustrated when I read of Vets who dont prescribe pain relief in situations like you describe.
Gut motility meds can be lifesavers *but* if given to a Rabbit with a GI obstruction they can be very harmful indeed.
I have had something of a run on Buns with GI problems recently and in all cases Metoclopromide was prescribed at some stage *but so was pain relief*
With a sudden onset abdominal pain/bloat it is really important for the Vet to establish that the stomach is able to empty, ie there is no obstruction. If in doubt the Vet should take an abdominal Xray before administering Metoclopromide.
I believe that a Bun with a gassy tum probably does need metoclop' as the pain from the gas will cause the GI tract to slow down and the last thing the Bun needs is to go into stasis with a belly full of gas. But pain relief is also an essential and my Vet has *never* omitted analgesia as part of her treatment for a Bun with GI problems

I hope your Bun is feeling much better by now

Janex

our vet noticed that Gizmo had bloat thought it could be gas that came on really quickly, but didnt give any pain relief. she was quiet all day we had her in the house then to keep an eye on her, but she didnt wee or poo at all that day and passed away less than 12hrs after seeing the so called rabbit vet.

I think gut stimulant should be given as soon as a rabbit presents with signs of bloat or stasis BUT ONLY when it has been established the cause is not due to a blockage.

I also think it is vital that it is given after any GA.

As I said before if my vet ever omitted to give pain relief for a rabbit with bloat or stasis I would park myself firmly in the consulting room until I got some.

when are gut stimulants really needed?

Hi,

I wondered also how a vet can be 100% certain that a rabbit does not have a blockage of some sort when it is initially taken in following an episode of gas/stasis? Wouldn't an x-ray be the only sure way to know? Yes, the rabbits tract may be slowing down, but in a case like my own rabbit, where I was fairly certain the tract wouldn't be slowing down too much, because I was keeping her well fed myself, the number one priority should have been to relieve the gas pain itself, nothing else at that point.

What my vet actually did was force an already painful gut to move by prescribing these motility meds without any pain relief, which is arguably the worse thing he could have done. My rabbit was definitely worse after this treatment and I'm not going back to this vet, I could have lost my rabbit.

I am not sure I would say gut motility meds are definitely needed after every GA, but I am going on my own experiences. My rabbits have had endless GA's for dental work, but although many vets routinely prescribe them afterwards, I have opted for my rabbits not to receive them. This is mainly because 1. Anytime my rabbits need a GA and may have stopped eating adequately themselves, I step in and syringe feed them too, ensuring their dropping output is good and I carry on syringe feeding afterwards too till they recover & gain appetite good enough on their own 2. My previous vets used to only offer metoclopramide and out of the two gut motility meds offered for bunnies, I would have preferred them to have had prepulsid, I did a bit of research on metoclopramide after I suspected a previous rabbit of mine may have had a bad reaction from it and although I could only find research on side-effects in humans, I have to say that it sounded like quite a nasty drug, it crosses the blood-brain barrier and can have irreversible side effects in humans. Yes, it may help some people & rabbits fine, but I was quite horrified when I read what some people went through when taking this, I can post some links if anyone wants to read.

Just to say aswell, I have got my rabbits through episodes of gas myself in the past too, when I haven't been able to get to a vets and all I've had was infacol on hand. Always treated them in the same way, regular doses of infacol, making sure well fed, maybe doses of a kitten hairball remedy if I suspected any excess fur to have been swallowed, fluids & gentle massages. This has always been enough ( although it has taken me a good few hours) to get them through it and thats without any intervention from a vet or any other type of meds, the only thing I wish I had of gotten was a stronger form of pain-relief on hand.

Truly sorry to hear about Gizmo, I was reading your post too and thought how similar the situation was to what I found myself in the other week.

Its good we're all agreeing on how vital the pain-relief is now and yes, thanks, Jane, my rabbit is doing a lot better *fortunately* after her recent bad episode.


All the best


Sue

I'm a bit confused, basically from reading this i've found that my vet killed Gizmo. She was on Metoclopramide, and she bacame increasingly worse after having this. she never had pain relieve either.

Their was nothing wrong with her on thursday night and then off her food friday. I need to know the truth, as i never want this to happen again.

I would point out that the act of feeding itself will not keep a gut mobile....infact force feeding a blocked rabbit or rabbit whose GI tract is immobilised will actually add to the problem as the food will simply sit in the stomach, had they not been provided with a gut stimulant.

As for after a GA I agree that I have had dental bunnies who never showed signs of stopping at all, even castrations who had their heads in the food bowl before coming round fully BUT offering a stimulant will not have a negative effect even if unnecessary and as a precautionary measure I personally, speaking as someone who nearly lost two does after a spey due to stasis, think it is well worth prescribing especially as vets are often unaware as to the varying levels of experience owners have when it comes to critical care.

Also to add, I have a rabbit who has chronic GI problems which are under investigation.

For the first fortnight he was here I pulled him out of stasis myself with Infacol, stomach acid stabiliser, syringe feeds, probiotics and tummy rubs.

I very nearly lost him about three weeks ago now because all I had done was treat the symptoms of his condition and we reached the stage where I alone could not bring him back. I rushed him into the vets as an emergency and a course of Metacam, Metaclopromide and sub-cuts were used by the vets and then me at home. It was three days touch and go as to wether he would pull through. After that he was on 6 medicines and 3 injections a day.

I have also discovered that Infacol gives Caspian the runs :?

Basically what Im saying is its all well and good treating the symptoms but if there is an undiagnosed underlying cause you can be doing more harm than good so I will always advocate taking a GI troubled bunny to see the vet.

Oh and sometimes....but not always.....a blockage can be felt in the GI tract.

when are gut stimulants really needed?

Hi,

I know what you mean when you say force feeding a rabbit with a blockage is not a good thing, but in that case, the rabbit is also going to probably present with gas pain, so force feeding not good & gut motility meds not good either. However, assuming you've caught a problem early and you are not initially *suspecting* a blockage, my number one aim would still be to relieve gas pain first.

If you are seeing droppings decreasing in size, a reduced intake of food from the rabbit or if droppings are non exisitant, then yes, I'd say the tract may be slowing down, getting more immobile. ( In which case, I wouldn't argue the possible need for gut motility meds) but I'm saying, that if I see this happening, I'd be looking to find a cause and treat rabbit accordingly if possible before it got to stages of rabbit ending up with a worsened condiition like terrible gas pain, but, I don't suspect my rabbit was suffering from stasis, just a gas attack, a reaction to something that caused some distension.

I just don't see a vital need for gut motility meds if you've caught a case of gas or stasis early, unless rabbit has been going downhill for a while, or you know the tract is slowing because of size of droppings, or perhaps virtually no droppings. If rabbits is presenting with gas pain from stasis or sudden onset of gas, I would still opt for pain-relief number one essential thing, if no improvement from that, then maybe I'd try a motility med, but like you say also, so long as you are not suspecting any type of blockage.

I remember having a tought time with my does after they were spayed too, didn't want to eat etc, but again, I think this relates to vets not prescribing pain meds (or possible effective doses of pain meds) to take home after spays, I don't remember being given any at all, I know better now and would definitely want them if doing it again.

This is just what I am finding from my experience,


Sue

Any rabbit that goes into my vets will have a GA followed by vetalgesic & emequell.

Any that are operated on will also have a antibiotic shot.

None of my does have ever been speyed without a painkiller and they all have a top up if need be at home (same for bucks). In the two cases I mentioned it was absolutely essential that they had a stimulant, else I would have had to get them into the vets as an emergency... as it would have done no good to syringe feed them otherwise.

I personally dont see an issue with prescribing it as a 'just incase', better safe than sorry and for a few pounds the peace of mind is well worth it.

I agree that painkillers are totally essential for cases of bloat and stasis but I also feel a gut stimulant is just as important to get the gas/gut moving....else you are treating the symptoms but not the cause.

Isn't metacam a painkiller? :? Maybe that's why your vet didn't give one?

As for the gut stimulants, my first rabbit Pepsi died after having one. I'd only had rabbits a few months, and I rushed him to the vets in a panic when he showed the symptoms of stasis, for the usual meds and was told to force feed him. He blew up like he had a football in his chest and died next day - obviously there was a blockage.

If I'd known then what I know now, I'd have taken the more gentle approach to treatment, and the blockage or whatever it was may well have passed along. I'm glad I got him painkillers though - horrible way to die

elve said:

Isn't metacam a painkiller? :? Maybe that's why your vet didn't give one?

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Good point Elve. Having just re-read OP's first post I have realised Metacam had already been given.
Also, I am a bit confused as to why an 'anti-anxiety drug' would be given. Unless it was for the muscle relaxant properties of Diazepam (Valium) :?

Janex

Id put that down to a typo...

when are gut stimulants really needed?

Just to clarify, my rabbit had an oral dose of metacam the day before she was seen by vet, but as metacam was a suspect in the initial 'gas attack' she had, I didn't want her to receive any more of this particular analgesic for the time being. She was also given an anti-anxiety drug, but I too was a bit baffled at how this was going to help her.

One other thing I will say is, that I have 2 rabbits that have had on-going dental problems for over 2 years now. They are probably very high risk bunnies for developing GI Stasis, gas problems because they go for monthly dentals (burring for overgrown molars and spurs) and are therefore going through a stressful situation every month. I catch their droppings decreasing in size frequently when their food intake drops due to mouth pain. I step in when I see this occuring and syringe feed (to ensure droppings stay plentiful and tract stays healthy/moving) until I can get them to the vets for their 'burring'. If I didn't step in and syringe feed, they would develop stasis or gas pain for sure, but I've been doing this for 2 years now and they come though fine from their dentals in this way. To add gut motility meds after every GA they go through, would just seem another added extra cost to me, when I just can't see a need. However, I do appreciate that others may feel safer to have this as a precaution.

Sue

What is infacol? I see the name mentioned on here frequently but what does it do?

My rabbit Crunchie frequently suffers from gas - three times in three months, most recently episode yesterday - we'd given her some cabbage and clearly it didn't agree with her (it didn't agree with me either but that's what made me realise it must be gas that she suffers from) but it seems to go through within 24 hours as she was fine this morning and has been fine the next day after all episodes. Last time we took her to the vet but they found no obvious blockage, just gave her some fibreplex, which I did yesterday too. Should I be doing more for her than that?

heleni said:

What is infacol? I see the name mentioned on here frequently but what does it do?

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Its a baby medicine which helps relieve gas. You can get it from pharmacies and supermarkets off the shelf

~bailey~ said:

Its a baby medicine which helps relieve gas. You can get it from pharmacies and supermarkets off the shelf

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Its very safe and can be extremely helpful in relieving gassy tummies but I would warn that it appears to give one of my rabbits the runs....no conclusive evidence though so possibly a coincidence.