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At my wits end with Urethritis and sludge HELP!!?

parsnipbun

Wise Old Thumper
I will try and keep this brief as I need IDEAS and HELP!

I am at my wits end with Teasal. He is 7 years old neutered male house/patio/lawn/everywhere bun.

About 3-4 years ago he was first noted as having the occasional sludge bladder. A year ago this was bad enough to be catheretred under GA and have it removed. It was then kept in control by maunual expressing every month or so and Frusol when it seemed to build up, and avoiding high calcium things.
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A month ago he had to have the whole thing cathetered out again - it took ages apparently and was solid. After that he went onto Septrin for 10 days, as well as metacam for a week. We also changed to a totally pellet free diet (before that we were on Burgess Excell for years and lately Science Selective).

He is now fed hay ad lib (meadow hay), and weeds basically (avoiding the high calcium ones) supplemented with carrots and the odd bit of fruit. We provide one bowl of just water and one of water with fruit juice (apple) mixed to try and get him to drink.. He has loads of exercise, is the right weight, perfect health otherwise, happy (except when he gets this), and active.

Yesterday I noticed him straining to wee again (less than one month after he was last cathetered), and took him to the vets. Sure enough its urethritis (although she cannot feel any sludge this time). There is no blood in the urine but he keeps just straining and spotting and his uretha is swollen and irritated.

We are now on metacam for a month, Frusol for a month, and Baytril for 10 days (last time it was Septrin) to try and 'break the cycle' (as the vet put it).

But I cannot understand WHY he keeps getting either sludge or (as this time) urethritis even when there is no sludge.

I asked for bloods and urine analysis but she said to do it in 2 weeks time after the meds.

Today he looks even worse and is just squatting every few seconds it seems like.

Can anyone think of anything we mght have missed??? (he has had Lapizole for EC and kidneys were fine when last x-rayed just a month ago).

Could it be something lacking in the diet?? Or is the water with fruit juice perhaps the wrong pH?? Is there some kind of magic balance we should be looking for with some other vitamin or mineral?

I am at my wits end - and so is he I think.

We have just oral syringed him 30mls of water t at least give him something to pee with but there MUST be a solution to this??? HELP

(PS I have 12 rabbits in all and Teasal is the only one with this problem).
 
I'm afraid I don't have any advice, but a friend of mine has just been through exactly the same thing. Her bun got to the point where he was being catheterized every couple of weeks, so she had to have him PTS. Her bun was being treated by the well known rabbit vet Guy Carter, but he couldn't give her any answers. :(
 
My friend who is a retired Doctor had this prob with her bun.She gives him three fronds of parsely a day and she says that it has cured him of the sludge prob.She also gives him fresh hawthorn leaves daily
 
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OXALATES! You're very should also have told you avoid feeding any oxalates. The sludge that builds up is calcium oxalate so you need to avoid foods high in calcium and high in oxalates. Carrots are extremely high in oxalates and you should cut them out of your bunnies diet completely.

You also need to be careful with what hay you feed, avoid anyhting with alfalfa. You say you use meadow hay, check exactly what is in it. Timothy Hay is the best as its very very low in calcium.

One of my bunnies called Charlie has had this all of his life, in the early days he'd get quite ill and we'd give him lots of subcutaneous fluids (ie we'd use a big needles to put lots of saline under his skin, which he would then absorb and wee for england!) which would flush his bladder through and then he'd be ok. It took me a while to get his diet right and learn how to notice the tell take signs. He was diagnosed at 3 ish, he's now 9 and hasn't had any issues with this since he was 4 ish.


Charlie's daily diet is:
- as much timothy hay as he wants (which he eats huge amounts of)
- breakfast - one quarter cup of science selective pellets between him and his partner
- dinner - one third cup of science selective pellets between him and his partner, with Cystaid sprinkled on. Cystaid is glucosamine which helps Charlie to repair his bladder wall where any sludge build up may damage it, (its all excellent for their joints!)
- veg - a handful of peas, few sprigs of coriander, few small squares of peppers/apple, half a strawberry, maybe a grape.

So fruit is mostly low in calcium and oxalates, but very high in sugar so should be given sparingly. Veg to avoid are all dark greens, carrots, carrot tops, peas in their pods like sugarsnap, beans, parsley, broccoli. I posted a full list somewhere on here and also one about glucosamine, I'll go find them and post the links.
 
Just remembered something else, water, obviously you're trying to get your bun to drink more and a splash of apple juice in the water works well - however, the other thing my vet advised was to give Charlie filtered water. I'm told the minerals in our tap water (especially if you're in a hard water area) contributes to forming the sludge. I just use a brita water filter.
 
I agree wholeheartedly with the water, buns who are prone to this build up do better with spring or filtered water:D

What you can do as well is to feed him Yarrow - it is really good for the waterworks department - I can vouch for that:D

Baytril is the antibiotic to go with though as it is the best for urinary problems.

Hope the changes in diet and water help the wee man and if you can, try and get some Yarrow and grow loads of it :D
 
Funnily I was going to suggest cystaid, it is for cats with cystitis, but we tried it on a bun we had who was passing blood. I seemed to help for a while but I do suspect she was suffering from uterine cancer and neither us nor the vets we so rabbit savvy at the time. We were actually advised by the company to double the dose as they thought a rabbit's system would have more problems absorbing it. I don't know if you get cystaid now, we now have cystease ( I assume the same thing ) for one of our cats.
 
Hi everyone:
Thank you SO much for these ideas.

Jack's Jane: No he has not had urine analysis recently - I asked for one this time round but she seemed keen to put him on Baytril and test in 2 weeks time. We were on Septrin before and I think she just wanted to get something started. I don't know if its in spasm - how would I know?? The vet didn't say it was when she looked at him yesterday. I can feel his penile structure inside him - it feels stiff. (sorry for detail). Would the metacam help with this?

Bev: Thats great. I did not know about oxalates - and had been giving him lots of carrots as we have so many!!! (although not giving him the tops). I shall try and check the oxalates levels in the food we give.

Interesting that you do use Science Selective as we were told to give up pellets all together - now I wonder if we should go back to them?

Trouble is we do not tend to feed bought veg etc as we have a large garden and two allotments plus the whole of the rest of the 150 plot site to wander over. So we feed all our buns on dandelions, grasses (all different kinds), milk thistle, plantain,. field bindweed, raspberry and blackberry leaves, apple tree leaves etc etc. And it is really difficult to get any info. on calcium (and presumably) oxalate levels of these. But now I know about oxalates I will try again to find more info.
If necessary and I can't find out we will try and switch Teasal from that diet to bought vegetables. Silly really as we don't have to buy any veg for ourselves!!

Anyone know the oxalate and calcium levels of fresh grass???

Bev: I have checked the site you suggested and now ordered some Cystease for him.

I did ask the man I buy my hay from what was in it and he said it was 'orchard hay' with no alflafa. I buy it in huge bales
(with 12 buns - I get through a bale a week - no idea what a bale weighs but before I found bales I used to buy x5 'bin bag' size hay bags a week from pet shops - and use much more sparingly).

I shall get Lisa at Hay Experts to send their lowest calcium hay and just have to use it for him only.

Jaypot: Oddly enough we were told by the vets NOT to used either filtered or mineral water but instead to boil it. For ages we boiled and filtered it - but then I kept finding calcium bits in the bottom of the jug full of boiled water and kind of gave up!
I shall go out and buy a filter again!!!

Bev (again) he hates his water with juice in - though his partner will drink the whole bowl at one sitting!!!

OK - so in total:
I have ordered Cystease to put on his food;
I am stopping carrots and Parsley immediately - and other high oxalate foods ( we have already stopped high calcium foods);
I will order the best low calcium hay just in case mine is high;
and I will go back to filtering the water (against vets advice).

Still undecided is to whether to go back to pellets or not. I guess it depends on whether I can find out the oxalate and calcium levels of the fresh food we collect for him.

Oh yes . . . and Anyone used Frusol before???? as this seems to be the 'lynchpin' of my vets approach.
 
Just had a look on google and frusol is frusemide. Don't know anything about it in rabbits, but it is used a 'water tablet' in dogs with heart disease. So it is basically a diuretic. I have also heard of it being used in guinea pigs having a heart attack, it helps to clear the fluid from the lungs. Sorry not much help really.
 
I just looked up Frusol in the BNF (British National Formulae, its the book Dr's use to get drug doses etc) and it appears its for humans aswell and is a diuretic. So its basically to encourage Teasal to wee. If you can get him to drink water you could take him off this.

You say Teasal doesn't like the water with apple juice in, I tried so many different pays to get Charlie to drink water - he went through a phase of loving strawberries so I used to whizz water up in a blender with a strawberry in it, or put a splash of innocent strawberry & banana smoothy in his bowl. Also, spraying the hay with water (but not all of it, incase he doesn't eat it) will help his fluid intake.

I also thought of taking Charlie off pellets but its the easiest way to get the cystaid/cystease into him, plus if I decrease his pellets any further he loses weight, infact I now have to feed him hazelnuts and oats to stop him losing weight. I seem to remember looking into pellets and deciding science selective were best at the time, however, I've since found pure timothy hay pellets - these would be excellent for a low calcium diet.

I know what you mean about trying not to buy veg, we have an allotment and grow most of our veg ourselves but because Charlie only eats peas and coriander we end up buying them. Cucumber is good, and they're easy to grow - added advantage of having a high water content.

I probably don't need to say it but try not to change his diet too quickley as you'll have other problems too!

Lots of luck, I really hope this helps. I'm not on here that often but if you think there is anything I can help with PM me.
 
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Metacam wont stop Urethral spasms. The spasms make him feel like he needs to wee even when he doesn't and he'll 'strain' and it'll hurt.
Diazepam is a muscle relaxant (aswell as a sedative) an it might help break the spasm-strain-pain-spasm cycle.

After he had the last catheterisation did he receive diuresis for a few days ? -ie subcutaneous fluids at 100ml/kg. This may need to be done on an 'every few days' basis longterm.
I have a Doe whose bladder needed expressing daily to remove sludge and she also required diuresis 4 times a week. Strangely enough now she is nearly 9 the problem has resolved ........ :?

Catheterisation can actually cause urethral muscle spasms so a Benzodiazepam (eg Diazepam) should be given after the proceedure.

Apparently a lack of a certain gut bacteria -Oxalobacter- can mean that calcium oxolate in the diet is not broken down and consequently uroliths/sludge occurs. In humans with this condition a probiotic -Oxolobacter formigenes- can be given to increase the oxolate reducing bacteria in the gut.
I dont know if there is a suitable preparation to give to Rabbits :?

Some Vets suggest giving Potassium Citrate orally to reduce the concentration of calcium in the urine.
 
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I have a Doe whose bladder needed expressing daily to remove sludge and she also required diuresis 4 times a week. Strangely enough now she is nearly 9 the problem has resolved ........ :?

Some Vets suggest giving Potassium Citrate orally to reduce the concentration of calcium in the urine.

As Charlie has got older his sludge problems have got better, I think this is because his kidneys are less effective so he drinks more, and wee's more etc.

I was told that Potassium Citrate would be the next step for Charlie if we couldn't control it by his diet. Parsnipbun - I have the recommended dosage written down somewhere if you want it.
 
Hi and many thanks again for all the helpful comments etc.

Pottassium citrate: This was my vets next option she said if the Frusol does not stabilise things. She is hoping the Frusol will make him wee more and thus drink more (alas I know Teasal well, he just does not like drinking anything - even fruit juices).

In the meantime i Have been trying to do some research on this.
I have read articles by Harcourt Brown (1996 and 2004) and Sharon Redrobe (Bristol) (2006) and some other material on the web.

I do not unfortunately come from a biological/chemistry/vet background so am struggling with some of it, However it does appear that there is a division between those who feel the sludge is diet related and those who feel it has a thyroidal basis (ie a thyroidal malfunction). If the latter, then again there is a division between those who feel that a low calcium diet will help and those who don't!!

As ever rabbit medicine seems to be in flux!

I see that the oxalates are more often involved in rat bladder sludge, and calcium carbonates or calcium phosphate is more often the sludge constituent in rabbit bladder sludge - I wonder if you had yours analysed Bev? I would like to have Teasal's sludge analysed as at least that would tell if there was any oxalate problem. (and free up some food sources if not!!). Does anyone know if there is a possibility of analysing the sludge?

This seems to have relevance for the oxalobacter that Jacks Jane mentioned as well. So analysis becomes more important - though as you say there does not seem to be a rabbit treatment for this.

I also noted from some water filter sites that normal jug filters do not really filter much calcium if any, and one needs one of the mega reverse osmosis systems to remove any appreciable percentage of calcium. We are contemplating getting one if it looks like it might be necessary - but lots of money!!

I am hoping the Cystease will help strengthen his bladder, and I am going to try and lessen calcium intake and have ordered the low calcium hay and iwll change to Oxbow T - though I am not sure I am going to cut out all weedy greens such as dandelions in the longer term.

He looks much more comfy today and I think maybe the combined metacam/abx/ and our giving 30mls three times a day orally of liquid is helping. (I realise 30mls is not a lot - but it helps).

I shall however remember the Diazapan in case he seems to get worse again or needs to be cathetered again.

I am DETERMINED to get to the bottom of this whole thing so am going to try contacting Francis Harcourt Brown to see what her latest thinking is and wheteher there are tests we can run on Teasal to try and find the actual cause.

Stay Tuned!!!
 
Hi there. I have a couple of dietary suggestions:

(1) If you feed a pellet, switch to Oxbow T which is timothy not alfafa based & should be lower in calcium.

(2) These veg are quite low in calcium so you could try suplimenting with:


Cauliflower
Peppers
Tomato
Endive
Squash/pumpkin
Kohlrabi
Lettuce (not iceburg though as it is rubbish...dark lettuce only)
Celery
cucmber
most fruits - bananna and tomato are high in potassium & bunnys usually love.

(3) Cranberry juice - great in humans for reducing both the pain of a UI infection and the likelyhood of it occuring. Two tablespoon a day either in a bowl if he will drink it neat or syringed. The acid also helps to break down sludge.

(4) Acidic foods/drinks might help reduce calcium build up (have you ever put vinagar on a pee stain!!!!) Maybe try lemon or orange in the water (or cranberry) to encourage him to drink or a probiotic from pets at home which has vitamic c added (vit c is acidic).
 
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Hi there. I have a couple of dietary suggestions:

(1) If you feed a pellet, switch to Oxbow T which is timothy not alfafa based & should be lower in calcium.

(2) These veg are quite low in calcium so you could try suplimenting with:


Cauliflower
Peppers
Tomato
Endive
Squash/pumpkin
Kohlrabi
Lettuce (not iceburg though as it is rubbish...dark lettuce only)
Celery
cucmber
most fruits - bananna and tomato are high in potassium & bunnys usually love.

(3) Cranberry juice - great in humans for reducing both the pain of a UI infection and the likelyhood of it occuring. Two tablespoon a day either in a bowl if he will drink it neat or syringed. The acid also helps to break down sludge.

(4) Acidic foods/drinks might help reduce calcium build up (have you ever put vinagar on a pee stain!!!!) Maybe try lemon or orange in the water (or cranberry) to encourage him to drink or a probiotic from pets at home which has vitamic c added (vit c is acidic).


According to my Vet Books dietry acidification is of no benefit :?

Gah...................flippin' Rabbits !! Why is nothing about them straightforward :rolleyes:
 
I am trying to put together as much as I can on this calcium metabolism thing.

If anyone has any other articles etc then please post references here (even if its only a reference and you have not been able to actually see articles - I can then try and get them. I am lucky in being a reader at the British Library and Cambridge).

If anyone else is interested in looking at this sort of stuff then I could help send copies of stuff in return for sae etc?

Also doing a table on calcium/oxalate/ etc extracted from all the various ones sent and found on google and very kindly given here. Trying to isolate difference between dried and wet versions of the vegetables (as most counts give it after drying which is the way you usually deal with measuring nutrient content - but useless for comparison when actually dealing with wet dandelion leaves !!). Having trouble with the 'weeds' etc that Teasal usually lives on. Calcium content of raspberry leaves anyone????

twigs (Parsnipbun) and Teasal

PS Ironically this is helping with feeding HIGH calcium foods to Parsley who has to re-build an area of leg bone that was 'missing' when he recently had to have his rear leg extensively pinned and plated after a bad break!!
 
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pellet is not that important, dr. susan brown, 1 of the contributor in the bk. "The 5 min. vet. consult -- ferret and rabbit", has stated that a bun diet should composed of 80 to 90% of timothy hay. So using 80% as a guide, the remaining 20% is pellet, green, treats and fruits.

The only other thing I want to add on top of the above is that in Dr. Hancourt-Brown's book, she has stated in more than 1 occasion, that obesity is 1 of the cause of your bun's problem.

Likewise, in the "5 min. vet consult", obesity is also mentioned as 1 of the cause.

So I am curious to know if your bun is over wt.? Because I am wondering the cause in the first place.
 
I had the exact same thing with my Missy years ago. When we first got her she had to have a couple of shockingly large stones removed, and then went on to pass one herself :shock: I don't know how on earth she did it, it must have been so very painful. Anyway, an Australian vet mentioned to me once he saw alot of this over here due to the water. She was a bit over weight at the time, but not much, so we cut her pellets, fed only hay (no alfarfa grass sp?) always gave low caluim veg, and changed to bottled water, at the time I think Volvic had the lowest calcium content. She went on to reach the grand old age of 10yrs, and we never had a problems with it again. :)
 
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