Questions about bloat - spoken to vet

I've just collected Mango from the crematorium, and although I'm still heartbroken, I'm feeling a little more clear-headed now. I'm not looking for more ammunition to beat myself (or the vet!) up with, but would really like to understand more about what happened to him, what treatment he had, what could have been done differently etc - my biggest mistake was not getting him to the vets sooner, but given how quickly it all happened, I could easily come home from work to find somebun in a similar state and would really like to learn from this.

So - I took Mango to the vets at about 10.30 pm. At this point his stomach was hard and very swollen. I asked later (after he died) if he had been in shock by this point and the vet said no (she didn't take his temperature while I was there though). The vet diagnosed bloat, and gave me the option of leaving him there or bringing him home. She said if I left him there they would put him on a drip, which obviously I couldn't do at home, although he would be split from Tulip that way. She said even if I brought him home I should split them, as it would be the only way to monitor his output. So - I opted to leave him there.

At this point I understood he would receive painkillers and something for gut motility. I asked if he would be x-rayed for a blockage, and the vet said it was unlikely a blockage, and that they would monitor him initially and just try to get his gut moving again. I guess this is my first question - can bloat occur without a blockage? Is it even possible to recover without surgery? Is it normal not to x-ray straight away? If not how long do you give it before you do? She did say he had quite bad bloat, but didn't seem overly concerned. I asked about the prognosis and she said 'they don't always make it, but we've just had one go home today after making a full recovery'. From what I've read since, is it right that bloat is very difficult to treat, and often fatal?

I couldn't sleep, and rang the vet at 4.30 am for an update. The vet came to the phone and said his bloat never reduced, but a short while ago he had nibbled some greens, which they saw as a good sign. Then just before I had called he had had a fit and died. Presumably this is a result of pressure on his heart? Why would he have eaten at all if he wasn't feeling better?

They had tried to resuscitate him without success, which doesn't surprise me given the state I left him in - I can only imagine the stress and pain his poor little body was under

This is what's listed on the bill: Catheter, 'giving set supreme' (presumably related to drip?), metacam, baytril (for the abscess she found at examination I think), emeprid (twice - gut motility?), adrenaline (not sure what for...).

It's obviously too late for Mango, but I really would like to know if I should have done something differently, or pushed for something else, so that I will be better prepared should it happen again. I've tried to read up about it, but not getting a very clear picture - confusion between bloat and stasis is everywhere - are they the same thing? I had always thought not. Mango had the odd bout of stasis, and so does Truffle, but I've never seen their stomachs like that before!

Any advice/tips/knowledge much appreciated - sorry for the long post.

With acute bloat then a partial obstruction/full obstruction is a real possibility and if the Vet had any doubts after abdominal examination then an Xray would be needed. Prokinetics are contraindicated if there is an obstruction.

Taking a blood glucose reading can also be a useful diagnostic tool, a blood glucose of 15+ - 20 definitely needs medical treatment- fluids, pain relief in the first instance, 20+ is frequently a surgical emergency.

Shock is a feature of acute bloat and usually the cause of death. The adrenalin on the invoice was most likely given in an attempt to resuscitate him

There is some useful information here

http://wildpro.twycrosszoo.org/S/00dis/PhysicalTraumatic/AcuteGIT_ObstructionRabbits.htm

I am very sorry you lost him

Thanks Jane.

I really don't know whether the vet felt there was no obstruction because she couldn't feel one, or because she just thinks it's unlikely because she's not that rabbit-savvy! Is it easy to tell by examination? So - if there was an obstruction, the emperid could have made it worse? Although presumably in that case even without it he wouldn't have stood much chance without surgery anyway?

I am left wondering at what point the vet might have decided to do an x-ray. I hate that with rabbits you can't just rely on the vet to know what's best - with everything happening so fast and the time of night, I didn't have time to do my own research.

Thanks for the link too Jane - I can see that even with surgery the odds would only have been 50/50, though I would have given him the chance as he was so young and lively. I will push for x-ray next time

I feel so angry at the vet now - he didn't stand a chance without that x-ray - I don't understand why they would just assume no blockage. He would have been better of pts than just left to die

argh - this wasn't the point of this thread!

Sleep time I think....

The Vet may have felt confident that there was not an obstruction. He/she may have felt that the stress doing an Xray may cause would be counter-productive at that stage. Obviously I cant say for sure, but the Vet may well have done what was appropriate in that given situation and sadly things just did not turn out as he/she had intended or hoped for

Vets can make mistakes, like anyone, but maybe poor Mango's case was one that could never have a happy ending He was on pain relief and he had even had a nibble of some greens. So whilst he was clearly very ill he was probably very 'out of it' from strong pain relief during his time at the Vets.

I am just so sorry he could not get better

Yes - I can see all that. Do you know what would cause such a bloat without an obstruction - can it be just stasis, even with all that pressure behind it?

Though I do also feel that attempting to medicate for 4 hours with no improvement, and still not investigating, perhaps wasn't wise.

So many 'what ifs'. I do hope you're right about the pain relief.

My instincts are the same as yours regarding 'why?' re x-ray on admission. I'd just have to go with Jane's possible explanation for that reason for not doing.

I'd also like to understand if/why bloat would occur without a blockage as logic tells me that the gas is building up because it can't escape, so what other reason would there be for it not to escape? And as I don't know any reasons (I'm sure there are some, I just don't know of them) then my logic also says strongly suspect a blockage if the rabbit is bloated - in which case I can't understand why you wouldn't x-ray.

I once took Rudy to OOH consultation and the vet said he "felt distended" then came back with three loaded injections without explaining what he was giving him. When I asked - quickly before he gave them, he said one was a gut stimulant. So I asked if there was a possibilty of a blockage - to which he said, "No". I was a bit :? :? because to me 'distended' meant that there was a build up of gas and I knew gut stimulant would be contraindicated if there was a blockage. The vet acted as if he knew what he was doing but wasn't involving me in the findings/treatment which made me very angry. I actually wish I'd interrogated him more as I no longer care if they feel interrogated - they need to know that I want to be involved. I actually felt that night that he was sending me home with a rabbit with a possible blockage who had been given a gut stimulant I never want to feel that fear again. The lesson learnt for me is ask, ask, ask, even if they don't like it. The vets who know me well now know I just want to learn and understand and that I'm not questioning their judgement (I hope they do anyway!).

I doubt you'll ever give yourself the answer you want regarding Mango's admission/treatment but definitely you could feel better prepared if it ever happens again by finding understand of what happened/didn't happen. When I lost Little Dot to blockage surgery I've often questioned whethere there was a possibility she would have survived without the surgery. The timing of the surgery was *possibly* because the vet was going off shift and there was no OOH cover that night. It was a tough call for the vet. I did feel resentful of circumstances for a while but then thought that as she didn't survive the surgery she was probably too unwell to have survived without the surgery. I think there is a point with these cases with rabbits that you are just damned if you do and damned if you don't.

I hope that even though the idea that he died in a strange place on his own was bad for you, that you may be able to find comfort from the knowledge that you were around to know he was ill and got him to the vets where he had a painkiller - and even felt like nibbling at one stage. That all that was actually better than not being found because he did at least have effective pain relief.

Yes I can't understand why the gas would build up without a blockage either. It makes more sense that it would be a result of that. I suppose if it isn't a blockage, then the only down side to doing an x-rayis the stress (although I admit I don't know what that involves), but if it IS a blockage, then without doing the X-ray poor bun is basically doomed - seems like a no brainer to me, but then I am not a vet.

I did ask twice actually about the x-ray - once when I took him and again when I left him - I asked whether he would be x-rayed if he showed no improvement. I cannot remember what the vet said! I certainly don't think I had the impression there was any intent to do anything other than 'try to get his gut moving'. I think my gut feeling was that he really needed the x ray, as that was what was playing on my mind and keeping me awake until I called for an update in the night, and that's what's upsetting me now - I feel like I should have gone with my gut and really pushed for it, or at least for an explanation from the vet why it wasn't needed so I wasn't left wondering now, or called earlier in the morning and asked again about it.

I didn't actually know it was bloat when I took him in though, so was relying on trying to dredge up tiny bits of knowledge I'd retained from other threads on here - at the time I was happy to take the vet's advice, and it all happens so fast - it was only my gut instinct telling me otherwise.

I think you're right - I have definitely learned from this - I really need to stop just accepting what the vet says, and being a bit more confident in questioning them.

I think I am ok with having left him at the vets now. I do feel awful that he was in a strange place but as you say hopefuly the painkiller was effective. Also, had I brought him home I would have brought him in to separate from Tulip as the vet said, so he would still have been alone and in a strange place to him. And that way, he would still have fitted and died, but in that situation I would definitely have been beating myself up more thinking he might have survived if I'd left him at the vets!

You have the opposite situation to me having lost a bun during surgery. I think I really feel surgery was a missed opportunity for Mango though - he blatantly wasn't improving without it so it would have been his only chance, though I understand success isn't guaranteed. I feel like between me and the vet we really screwed up and let him down - he should have had the chance at least.

I am wondering whether I should ask the vet now what their reasoning was - just to learn. But terrified I'll find it's just becasue they didn't know what they were doing, and then I'll blame myself even more. Maybe better to just leave it alone?

esupi said:

I am wondering whether I should ask the vet now what their reasoning was - just to learn. But terrified I'll find it's just becasue they didn't know what they were doing, and then I'll blame myself even more. Maybe better to just leave it alone?

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It depends on how you are at dealing with the information. I've often avoided asking but now years later wish I had. I know I let Scrabble down really badly (over 5 years ago) and the vets did too. I discovered Frances Harcourt-Brown's practice only 3 weeks later:roll:. Scrabble was admitted in stasis, I didn't know at that time I needed to get her to the vets quicker, it was over 12 hours of pain and not eating. The vets did x-ray her but the x-ray wasn't clear (I needed clarification on that as to why it wasn't clear but never asked), they couldn't take a blood sample because her blood pressure was too low. The vet could feel a mass in her abdomen and decided on exploratory surgery - yet no one told me that she had a severe upper respiratory tract infection - they put her in an oxygen tank but didn't say why. My medical knowledge was extremely limited at that time, so I wasn't able to figure out any conclusions for myself. She died before they could perform surgery. No explanations, nothing. I could have at least done with "it was probably organ failure" etc even if the reason wasn't known. At the time I was just so stunned that I'd lost my beautiful Scrappy that I never asked the questions I should have asked. Now I want as much information as possible, at that time my thinking was she was dead and I couldn't change it so didn't think the whys and what ifs matter... they still do 5 years later!

So, if you think knowing will distress you more than it may be best not to ask - if you think it will help you get a different outcome another time or feel more accepting of the outcome this time round then ask. I've found that using FHB's practice they like to do a PM for unexpected deaths and that has helped me enormously, it's helped me know that for me having the answers is better than not having them.

I think if they had a genuine reasoned case for not doing the x-ray, either when I took him or at any point during he subsequent few hours, and really thought if offered his best chance, then it would make me feel better as everything was done with his best interests in mind.

If, alternatively, they didn't x-ray because they 'just thought' a blockage was unlikely, or thought medicating was just always the way forward with bloat, or some other sort of ignorance, then it will make me feel worse, as I will feel that if only I had known more, then I could have pushed for it and given him a chance. It will also make me feel very angry towards them for not researching and finding out if they didn't really know.

If I'm honest, I suspect the latter - the vet really didn't seem very interested in discussing x-rays/surgery as options
I am not sure either way whether it'll make any difference in the future, as the lesson is to get them to explain why at the time and if they don't know, find out, or get them to!

Maybe I need to give it a few more days - I thought I was feeling better yesterday, but have definitely taken a backwards step this mornign.

esupi said:

I think if they had a genuine reasoned case for not doing the x-ray, either when I took him or at any point during he subsequent few hours, and really thought if offered his best chance, then it would make me feel better as everything was done with his best interests in mind.

If, alternatively, they didn't x-ray because they 'just thought' a blockage was unlikely, or thought medicating was just always the way forward with bloat, or some other sort of ignorance, then it will make me feel worse, as I will feel that if only I had known more, then I could have pushed for it and given him a chance. It will also make me feel very angry towards them for not researching and finding out if they didn't really know.

If I'm honest, I suspect the latter - the vet really didn't seem very interested in discussing x-rays/surgery as options
I am not sure either way whether it'll make any difference in the future, as the lesson is to get them to explain why at the time and if they don't know, find out, or get them to!

Maybe I need to give it a few more days - I thought I was feeling better yesterday, but have definitely taken a backwards step this mornign.

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Why not ask to speak with the Vet who treated Mango ? I would in your situation.

They should know how to deal with it though and if they don't should admit they don't, and maybe send you somewhere more competent. Try not to feel you let him down, you got him to the vets, *if* they didn't do all they could then they let him down, not you. Rabbits are the 3rd most common pet - shame on them if they can't deal with this type of emergency competently either themselves or to find you someone who can. You did all you could within the realms of your knowledge which is a damn sight more rabbit savvy than the average owner. You did not let him down. I think we are all in the lap of the gods that the vet on duty on the day we have a genuine emergency isn't the one with the knowledge/skills we need. I think this is a case of hindsight being a wonderful thing. I know the feeling well enough of leaving them there/leaving a consultation and not being 100% sure of the competence of the vet. Losing a rabbit the way you lost Mango is a huge shock, I've come to the conclusion from similar events that I can do my best to get them to a rabbit savvy vet but I can't absolutely guarantee that I can when we have a time-limited emergency - it's a hard realisation to face

Jack's-Jane said:

Why not ask to speak with the Vet who treated Mango ? I would in your situation.

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I think I will keep it in mind - I definitely don't have the strength right now, but presumably within the next week or so would be ok.

Buny Buddy - 'within the realms of your knowledge' is the key - you can always feel bad for not having known more! Maybe I should retrain as a rabbit vet! haha.
Funnily enough I did consider being a vet when I was younger, but there's no way I'm strong enough emotionally - I'd be a constant wreck!

Having dealt with bloat in my rupert, I can say yes bloat can happen without a blockage - he's had bloat 6 times now - each one caused by something different, and only once could the vet feel a blockage (which then passed luckily).

Rabbits can't burp, so when they get gas, they need help to get rid of the gas - they're like us, the gas can be caused by anything - food, fur, fear (if they stop eating). In our case, the first time was probably caused by apple snack treats, second time was swede, third time was unexplained (the blockage), fourth time again unexplained, dealt with at home (infacol, tummy massage), fifth time unexplained (most probably the thunder), sixth time (just this week) him eating hamster food from the hamster cage :roll: - dealt with at home with infacol, tummy massage, chsing him and metoclopramide.

Acute bloat (which I think you bunny must have had) is (so im told by the various different emergecny vets we've had to see with Rupert) - can be caused by all of the above - but it becomes acute if it can't be moved on quickly.

I think if his tummy was so hard and swollen, they hsould have really x rayed him They should know how to deal with bloat, as it's so common.

I'm so sorry for your loss and I hope that you get the answers from the vet. Bloat is evil, thinking of you x

Rupert & Tia said:

Having dealt with bloat in my rupert, I can say yes bloat can happen without a blockage - he's had bloat 6 times now - each one caused by something different, and only once could the vet feel a blockage (which then passed luckily).

Rabbits can't burp, so when they get gas, they need help to get rid of the gas - they're like us, the gas can be caused by anything - food, fur, fear (if they stop eating). In our case, the first time was probably caused by apple snack treats, second time was swede, third time was unexplained (the blockage), fourth time again unexplained, dealt with at home (infacol, tummy massage), fifth time unexplained (most probably the thunder), sixth time (just this week) him eating hamster food from the hamster cage :roll: - dealt with at home with infacol, tummy massage, chsing him and metoclopramide.

Acute bloat (which I think you bunny must have had) is (so im told by the various different emergecny vets we've had to see with Rupert) - can be caused by all of the above - but it becomes acute if it can't be moved on quickly.

I think if his tummy was so hard and swollen, they hsould have really x rayed him They should know how to deal with bloat, as it's so common.

I'm so sorry for your loss and I hope that you get the answers from the vet. Bloat is evil, thinking of you x

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Why isn't the gas passing downwards though? I get that they can't get rid of the gas upwards but why can't they expel the gas downwards?... unless the route is blocked? I know they can get a bit gassy as I've dealt with loads of stasis episodes but it's the definition between gassy/stasis then bloat then blockage that I'm finding hard to pin down. I've dealt with loads of unexplained stasis episodes that could be gas but not bloat because there wasn't a blockage, a few that were gas build ups because of a blockage... a few I thought that were bloat until a vet told me "rabbits don't get bloat":?.. which is interesting because a few weeks earlier his wife explained to me how to tell the difference between stasis and bloat :? I've learnt that stasis isn't an emergency to the same degree as bloat/blockage but it's telling those things apart that is the problem.

Edit to add: I'm not expecting you to have the answers by the way! It's just something I want to understand but don't.

Bunny Buddy said:

Why isn't the gas passing downwards though? I get that they can't get rid of the gas upwards but why can't they expel the gas downwards?... unless the route is blocked? I know they can get a bit gassy as I've dealt with loads of stasis episodes but it's the definition between gassy/stasis then bloat then blockage that I'm finding hard to pin down. I've dealt with loads of unexplained stasis episodes that could be gas but not bloat because there wasn't a blockage, a few that were gas build ups because of a blockage... a few I thought that were bloat until a vet told me "rabbits don't get bloat":?.. which is interesting because a few weeks earlier his wife explained to me how to tell the difference between stasis and bloat :? I've learnt that stasis isn't an emergency to the same degree as bloat/blockage but it's telling those things apart that is the problem.

Edit to add: I'm not expecting you to have the answers by the way! It's just something I want to understand but don't.

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No vet I've asked can answer that question, its so frustrating - but I KNOW bunnies can trump cos mine do :roll: i think maybe the gas 'bubble' just gets too big and it can't get thru - like us having trapped wind....

My vets miss the point, they say he's got bloat because he stops eating and not one will listen that he doesn't stop eating UNTIL he gets the gas ... the gas makes him stop eating!

It's so hard to understand isn't it, because it seems like every vet says something different

Of course, there's always the chance there's an underlying problem which is what causes the stopping eating then the gas is caused due to the stasis - BUT in our case, he literally eats eats eats.... then gets gas and stops eating - and its like he wants to eat but is in pain (from the gas). Its awful

I just wanted to say that I'm so sorry for the loss of your rabbit. I lost a rabbit to stasis, and it can be heart wrenching to go through. I know in my case that the vet should have taken xrays and didn't, but also my inexperience didn't help either. You will learn from this and be able to know better what to do if anything like this happens again. I know that it isn't much consolation now though. After the loss of my rabbit, I set about to learn all I could about stasis and not long after I had another rabbit go through it repeatedly, but this time I was better prepared in knowing how to handle it, and had a much better outcome, thankfully.

I haven't had a rabbit with bloat but I've read of many other experiences with it, and I'm familiar with a lady who's rabbit has gone through it repeatedly, and her rabbit is only 4 months old. He was rescued from a trash can when he was about a week old and not long after that he started having almost constant bloating problems. She had been to the vet many times. He had been on meds, electrolytes, probiotics, critical care, pellets, and hay after she weaned him. And at home she was constantly having to give him simethicone and tummy massages to try and get the bloating under control. Surprisingly it didn't prove fatal, despite how bad it was all of the time. It was suggested to her to try a hay diet, but the vet kept pushing meds and pellets, so after several more weeks of him going through this and then developing stasis along with the bloat, she made a bit of a breakthrough as he was getting better. His bloating had gone down and he seemed to be doing well, she then gave him his electrolytes and immediately he started bloating again. She had discovered that he was sensitive to the sugars in the supplements, meds and pellets. Since then she has cut everything out of his diet and feeds only timothy hay and minimal meds, as he does still need motility meds. The bloating is much more under control and occurs with a lot less frequency now, with some occurrences of gas because of his ultra sensitive stomach.

So a rabbit being sensitive to certain foods can be a cause of bloat, as well as a blockage, parasites and bacteria, or other unknown possible causes. There really is some uncertainty about why bloat occurs sometimes. I think the problem encountered with bloat is that there is an explosive buildup of gas caused by something, and like our digestive system, things only move through at a certain speed. But like was mentioned, we can burp and rabbits can't, so they can only expel gas in one direction and that is limited by the speed it is able to pass through the digestive system. And because it isn't just a little gas, but is a large amount that suddenly occurs, that further complicates things, because it can't be easily expelled, and can continue building and putting pressure on sensitive internal organs.

The difference between stasis and bloat is that bloat is a distension of the belly and GI stasis is a slowdown of the digestive system. The two terms are basically just a description of symptoms, but can have various causes, and can occur at the same time or occur consecutively. A rabbit could develop stasis first, then have a sudden overgrowth of bacteria and/or pressure from nothing moving through, that causes the bloat, or it could have a reaction to a food or other cause, and have sudden bloat that then leads to a slowdown of the GIT and stasis and a possible blockage occurring. But either way, bloat is the most immediate concern as it is the most life threatening.

You can check out this link if you want. It explains a little bit about bloat. Just be aware that if you do some exploring on this site, there are some pretty graphic pictures under some of the categories.

http://www.medirabbit.com/EN/GI_diseases/Bloat/Bloat_ena.htm

First of all...I just want to send some ((((((hugs))))) and say again how sorry I am that Mango has gone.

I don't know if this post will be helpful regarding bunnies, but I do have experience with bloat in dogs and wonder if it is not a similar mechanism in rabbits that causes this condition:
I have never seen bloat in any of my rabbits, and one would hope that a vet would know the difference between bloat and stasis, but I wonder if that is what the vet mistook this for. I also can't understand why xray wasn't their first option.

I had two elderly dogs go through gastric dilatation and volvulus (GDV for short) where the stomach fills with gas, usually from bolting food, and then twists, effectively blocking off not only the lower digestive tract but the esophagus as well and the distended organ presses upon the heart and diaphragm. As this condition continues blood flow is cut off and toxins begin to build in the system, causing pain and anxiety in the animal, plus tissue death, coma and death of the animal can occur as well if the stomach is not deflated and rotated back to it's proper position. It is something that can be easily seen on xray.

Both dogs were diagnosed and operated upon within an hour of the onset of this condition. Each dog recovered after a lengthy convalescence but to keep the stomach from twisting again, they each needed their stomachs tacked to the musculature of the abdomen; a gastropexy involves opening the abdominal cavity to perform the procedure.

I am not certain this kind of operation is particularly effective or even offered in rabbits as they can deteriorate so rapidly from a number of conditions, never mind the multiple challenges of this horrible illness. Bloat is simply a very deadly disorder and I think the ones that make it through are the exceptions, not the rule.

It is entirely and sadly possible that Mango could not be saved, which is tragic beyond words, as there was nothing either you or the vet could have done differently to affect the outcome. If it would be beneficial to speak to the vet on his case to help yourself sort all this out, I would do it. I often question my vets and, although I am certain it annoys them on occasion, I have had few instances where someone is not willing to explain to me why they did what they did and to what end rather than leave me stewing and those that brush me off are no longer in my employ.

I really hope you can find some answers and that these answers will help ease your mind and heart. You have lost a dear companion and naturally you want to know why. (((((((((((((((more hugs))))))))))))))
Bless you. xxxx

I dont know if this will be of any help to read

http://www.medirabbit.com/EN/GI_diseases/Bloat/Bloat_ena.htm