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Please Note - Medical Advice
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Gastric ulcers and metacam?
- Thread starter MimzMum
- Start date
Jack's-Jane
Wise Old Thumper
In theory NSAIDs do carry a risk of causing GI tract ulceration. However, Rabbits already have a very highly acidic stomach in 'normal' circumstances. So this must imply that they are more able to tolerate NSAIDs than some other species. Otherwise the 'normal' gastric acid would cause problems, there must be an in built protective element to the structure of their stomach lining.
Also, unlike other species a Rabbit seldom has an empty stomach. However, if the Rabbit is eating very little then the Vet may feel that prescribing a histamine H2-receptor antagonist, eg Ranitidine, to protect the stomach lining would be beneficial. I have had numerous Rabbits on a relatively high dose of Metacam and none have ever had any issues with GI tract ulceration as a result. But that is not to say that it could never happen.
Symptoms of GI tract ulceration include abdominal tenderness, GI tract hypomotility (reduced intake and output), blood haematology/biochemistry may show anaemia and/or inflammation. Fecal testing may reveal occult blood.
Hope your Bunnies are OK ?
What Jane said, but it depends what you mean by long term and what the reason for the long term use is. For example my bunny Fandango is on the maximum dose twice a day to help with a tumour in his thymus region. He is on this permanently for its anti-inflammatory benefits. It was prescribed by an exotics specialist as a safer alternative to steroids. It's often about weighing up the balance. The Text Book of Rabbit Medicine (second edition by Molly Varga) states that doses as high as 1.5mg per kg can be used without cumulative effect. (Thats 1ml per kg of the 1.5mg dog solution)
With regard to not being able to utilise oral pain relief, if there is a reason NSAID's cannot be given (kidney disease being a prime example) then other pain relief can be used - such as tramadol, which is available in liquid and tablet form. Vetergesic can also be used orally but is more difficult to administer as it needs to be absorbed through the mouth rather than swallowed.
I think wherever possible regular bloods are good for any bun on long term meds
With regard to not being able to utilise oral pain relief, if there is a reason NSAID's cannot be given (kidney disease being a prime example) then other pain relief can be used - such as tramadol, which is available in liquid and tablet form. Vetergesic can also be used orally but is more difficult to administer as it needs to be absorbed through the mouth rather than swallowed.
I think wherever possible regular bloods are good for any bun on long term meds
MimzMum
Wise Old Thumper
Thank you everyone. My mind is put at ease by your replies. 
Jane, I know I keep asking this question on the safety of pain relief for bunnies, but since all three of mine are now on daily metacam doses I am always vigilant that nothing secondary occurs as a result.
Pip and Fiver have only been taking it regularly for about a year, but I worry that either of them might develop stomach issues since both recently went through severe bouts of stasis. I'm fairly sure Fiver's was due to a bad reaction to baytril combined with his not being able to rise from laying down contributing to stress...but Pip may have ongoing bladder issues that would require long-term inflammation control. If she stops eating again I don't want to cause more trouble for her with metacam but don't see how I could stop using it with her other issues. :?
It's Mimzy who most concerns me. He just doesn't seem to be doing well. We're going through some oppressive heat here and that's going to switch to possible snow by Sunday :shock: and we've also had storms go through here that change up the barometric pressure and must be playing havoc with his arthritis. My good vet who wanted to try him on tramadol and gabapentin doesn't have any scheduled clinic days for June and I fear she's not coming back. The vet who deals in exotics now has made it clear that he's not raising any metacam doses and doesn't believe in using ranitidine to protect bunny tummies. I despair and fear that without better pain control and veterinary support I will have to make a very hard decision for Mimzy, and it infuriates me because I'm sure he could continue to do well if we could just get this issue sussed once and for all about metacam dosing in rabbits. But at the same time I worried that maybe his discomfort came from the effect of this off label use of this drug on his stomach. However he still eats and eliminates well and is eager for a fuss and a treat anytime, although being a somewhat deaf bunny with limited vision, he needs other stimulus to get that message across without frightening him. Trips to the vet you can imagine are pretty traumatic for my poor boy.
Long story short I was mostly looking for likelihood of him having stomach problems now instead of just back/leg pain but I think it is unlikely from what you describe. However if my advocacy for him is going to fall on deaf ears I'm at a loss as to how I proceed from here. There are no other rabbit savvy vets in my area at present and this can't be left until after we move, obviously.
I'd like him to have bloods drawn but this vet feels the need to anesthetise for this and outside of Mimzy needing a dental I think that's extreme. My guess is it's just a way to drive the price of treatment up or he's simply not confident in his own abilities, which I find hard to believe considering he brought Pip back from the brink just a few short weeks ago. Mimzy's prior vet would have him in the back and out again in a matter of minutes. :?
By the way all three buns use the dog strength. Mimzy is at 0.5 mls twice daily, Pip at 0.4 mls twice daily and Fiver at 0.3 mls twice daily. I always make sure to feed them a treat at medicine time so they aren't taking it empty. Weights are a guess at the moment but I think Fiver is almost 3 lbs, Pip is around 5.5 lbs and Mimzy hasn't been weighed lately but I think his last weight was around 3 lbs also.
Jane, I know I keep asking this question on the safety of pain relief for bunnies, but since all three of mine are now on daily metacam doses I am always vigilant that nothing secondary occurs as a result.
Pip and Fiver have only been taking it regularly for about a year, but I worry that either of them might develop stomach issues since both recently went through severe bouts of stasis. I'm fairly sure Fiver's was due to a bad reaction to baytril combined with his not being able to rise from laying down contributing to stress...but Pip may have ongoing bladder issues that would require long-term inflammation control. If she stops eating again I don't want to cause more trouble for her with metacam but don't see how I could stop using it with her other issues. :?
It's Mimzy who most concerns me. He just doesn't seem to be doing well. We're going through some oppressive heat here and that's going to switch to possible snow by Sunday :shock: and we've also had storms go through here that change up the barometric pressure and must be playing havoc with his arthritis. My good vet who wanted to try him on tramadol and gabapentin doesn't have any scheduled clinic days for June and I fear she's not coming back.
The vet who deals in exotics now has made it clear that he's not raising any metacam doses and doesn't believe in using ranitidine to protect bunny tummies. I despair and fear that without better pain control and veterinary support I will have to make a very hard decision for Mimzy, and it infuriates me because I'm sure he could continue to do well if we could just get this issue sussed once and for all about metacam dosing in rabbits. But at the same time I worried that maybe his discomfort came from the effect of this off label use of this drug on his stomach. However he still eats and eliminates well and is eager for a fuss and a treat anytime, although being a somewhat deaf bunny with limited vision, he needs other stimulus to get that message across without frightening him. Trips to the vet you can imagine are pretty traumatic for my poor boy.Long story short I was mostly looking for likelihood of him having stomach problems now instead of just back/leg pain but I think it is unlikely from what you describe. However if my advocacy for him is going to fall on deaf ears I'm at a loss as to how I proceed from here. There are no other rabbit savvy vets in my area at present and this can't be left until after we move, obviously.
I'd like him to have bloods drawn but this vet feels the need to anesthetise for this and outside of Mimzy needing a dental I think that's extreme.
My guess is it's just a way to drive the price of treatment up or he's simply not confident in his own abilities, which I find hard to believe considering he brought Pip back from the brink just a few short weeks ago. Mimzy's prior vet would have him in the back and out again in a matter of minutes. :?By the way all three buns use the dog strength. Mimzy is at 0.5 mls twice daily, Pip at 0.4 mls twice daily and Fiver at 0.3 mls twice daily. I always make sure to feed them a treat at medicine time so they aren't taking it empty. Weights are a guess at the moment but I think Fiver is almost 3 lbs, Pip is around 5.5 lbs and Mimzy hasn't been weighed lately but I think his last weight was around 3 lbs also.
bunny momma
Wise Old Thumper
Dosage has a lot to do with how safe Medicam is for a rabbit. My own vet warns about kidney failure at the higher end of the dosage range, but he also understands that Medicam can help an ill rabbit recover. He is not adverse to giving a higher dosage for several days. My elderly almost 1kg (2.15 lb) rabbit is on Medicam at .13ml every 12 hours. This is the Medicam that is 1.5mg per ml. This means my rabbit gets approximately .2mg every 12 hours. Medicam helps both pain and inflammation, and sometimes the second is just as important as the first. I was informed that some narcotic pain meds are known to slow digestion which is not what you want to do with any rabbit who has problems with stasis.
I forgot to ask how we would control inflammation if he had a separate med for pain.
I forgot to ask how we would control inflammation if he had a separate med for pain.
MightyMax
Banned
Agreed :thumb: This is why I am entirely reluctant to use Vetergesic or Tramadol. The soporific effects are quite worrying.
Jack's-Jane
Wise Old Thumper
duplicate post !!
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Jack's-Jane
Wise Old Thumper
Tramadol actually has minimal effect on gastrointestinal motility compared to other opiates
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2125.1997.tb00140.x/pdf
However, it does have some effect in reducing motility
http://www.iasj.net/iasj?func=fulltext&aId=6516
But at a well controlled dose it can be used safely when a high level of analgesic cover is needed and Metacam does not address this
After all, severe pain slows down gut motility too due to the release of catecholamines as a response to pain. A good Vet will weigh up all the pros and cons about using Tramadol depending on the individual Rabbit being treated. As is always the case there is never a 'one size fits all'
We use Tramadol for my Rabbits who need analgesic cover additional to or instead of Metacam. It is an extremely useful drug and at the moment it is keeping 10 year old Dermot content and comfortable. It has also helped many of my other Rabbits and the majority of Rabbit Savvy/Exotics qualified Vets prescribe it.
M, I would always prefer to have a Rabbit on pain relief to manage a chronic pain condition, even if there might be some risks involved. Again, I am very fortunate to have C to advise me about what to do. I understand that for you Rabbit Savvy Vet care is not always readily accessible due to your geographical location xx
