Leo is not himself today...Leo on a day visit U/D 24

[a reader of books]

Oh, that's lovely that he'll be able to be at home with all of you. Sending him so many vibes. I hope he'll feel better being at home and will do some poops and can get some cuddles from Flo.

 

[Craig 1965]

Omi - thank you for your thoughts. I believe Leo is on gut meds - I’ll double check. He is going to be on paracetamol only as they will withdraw the ketamine. I will of course take him straight back if I feel Leo is uncomfortable or struggling. I feel Leo needs to look settled, as comfortable as he can be (with a tummy wound) and looking to move rather than just staying one spot. I won’t be allowing him outside until he’s comfortable indoors and generally speaking both flo and Leo usually spend the afternoons indoors. I agree 100% with you that after only 3 days post op, this is a massive step and will be exhausting for Leo.
Jane - as ever, your knowledge exceeds most and I’ll speak to the vet about the metacam situation just to be able to pass on that perspective to everyone. I think collectively we have all learned a lot over the last few days, not least rabbits having appendix.
Flo has been very down these last few days - 10 minutes ago she was doing the most amazing zoomies round the house. I do not know why she was doing this.

 

[a reader of books]

Aw, I'm sorry Flo has been so down. I hope those zoomies mean she's feeling a little happier.

 

[susie bun]

Bertie sends best wishes to Leo and Flo. Thinking of you too Craig! xx

 

[Craig 1965]

This is Leo at home just now

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We picked him up at 10 oclock. The vet said there is a slight change to his plans today as they are so very busy at the moment (emergency out of hours vet service on a sunday). They said tea time is their busiest time so could we drop Leo off at 5 o'clock and then pick him up again at 11 oclock instead of bringing him, taking him home then bringing him back at 11pm for his night time meds. I was happy with this. It is less problematic for the vets and means that Leo can get the meds he needs and is less strssfull than picking him up, putting him in the carrier and going back and forth.
He has eaten a small amount - his eating is much slower and seems laboured but he's had some herbs and a few carrot tops. He ran from living room to kitchen but this seems to have taken every bit of energy out of him. He looks utterly exhausted. I feel that the operation has taken alot out of him and his recovery is slow. I suspect he is in considerable discomfort, but in a way I hope this is all he is in. I don't mean that in a bad way - I just mean that I hope there are no complications other than this is a massive operation for him, very invasive surgery and it will just take time for him to slowly recover. It's very heartbreaking for me to see Leo like this as I wish I could make him better quicker, but his body needs to have time to heal and it's just going to be slow.
I'm certainly not allowing him to go outside because he's incredibly vulnerable, he's not really steady on his feet, he's got a big tummy wound with stiches and I don't want to have him catch that on anything or make it worse so as nice as it is outside, he's going to be confined to indoors where he can just rest in familiar surroundings.
Thank you all for your contiued vibes
Craig xx

 

[a reader of books]

Hello, sweet Leo. I can imagine that it must be so difficult emotionally to see him like this, yes. We can feel so helpless when they're so poorly and there's nothing we can do for them other than give them a peaceful, comfy place to recover. It looks like Leo has that, with his blanket and his buffet close by. It's good to hear he has eaten a little bit. It probably takes effort for him to eat, being so exhausted... It definitely sounds like the right decision not to let him outside while he's so vulnerable. Has Flo been with him, or is she keeping her distance? I hope it'll do them both some good to see each other again, but as we talked about in another thread the other day, bunnies can act strange (to us) when their partner is poorly. Sending Leo lots and lots more vibes. Thank you for keeping us updated on how he's doing like this, Craig.

 

[Omi]

I agree it seems he's had quite an invasive operation and so recovery is going to be slow. I imagine that unlike, say a leg op on a bunny, his whole digestive system is repairing, so eating and pooing is going to possibly produce pain in itself. Also with any operation a lot of the pain element is due to inflammation. If he can't have Metacam or other anti-inflammatories, that will also not be relieved. Paracetamol, as far as I know, is just a pain relief. If they intend to give Paracetamol at 5pm and 11pm, then they are anticipating that the relief will last approx 6 hours. It might be then that you start to see an increase in his pain levels the closer it gets to 5pm. Resting is good for him in my view.

It must be very hard to see him like this, but recovery from a major operation is tough.

I'm pleased that you don't have to take him there and back twice this evening. Far better that he stays and rests inbetween. I would also agree with your decision not to let him outside. I don't think that any possible benefit is worth the risk tbh.

Come on little lad, start giving us mountains of poo, please.

 

[InspectorMorse]

I agree it seems he's had quite an invasive operation and so recovery is going to be slow. I imagine that unlike, say a leg op on a bunny, his whole digestive system is repairing, so eating and pooing is going to possibly produce pain in itself. Also with any operation a lot of the pain element is due to inflammation. If he can't have Metacam or other anti-inflammatories, that will also not be relieved. Paracetamol, as far as I know, is just a pain relief. If they intend to give Paracetamol at 5pm and 11pm, then they are anticipating that the relief will last approx 6 hours. It might be then that you start to see an increase in his pain levels the closer it gets to 5pm. Resting is good for him in my view.

It must be very hard to see him like this, but recovery from a major operation is tough.

I'm pleased that you don't have to take him there and back twice this evening. Far better that he stays and rests inbetween. I would also agree with your decision not to let him outside. I don't think that any possible benefit is worth the risk tbh.

Come on little lad, start giving us mountains of poo, please.

Ditto to all of the above

Also, is the Vet intending to run another blood profile ? And a random thought, would giving him oral Colostrum be of any benefit ?

https://watermark.silverchair.com/5...HWW1KBrOwf7sFqXeDALK0nePE5ox9yHLSfUfPP5vNyIyQ

 

[Craig 1965]

Thank you Omi and Jane. I'll be honest with you both - this is emotionally hard on me. Not to take anything away from Leo, because this is his body and his recovery, but watching him like this is as hard if not harder than worrying about him when he was at the hospital. And I've worried non stop because I so desperately am hoping and praying he can pull through. There;s little I can find on the internet regarding what is 'normal' for recovery times other than post op neutering which seems to indicate males recover 24/48 hours after and are generally fine. This however is not comparable to a neuter.
There's no poop from him in the time he's been here. He's nibbled a bit of parsley, had a bit of carrot top and 4 leaves of dandelion. His eating was slow with the parsley and carrot but did seem to be quicker with the dandelion. If you try to put more food down for him, he just gets up and moves away as if he's saying "no thanks" so it's hard to find that balance between getting him to eat but not forcing it. The vet was clear this morning she didn't want him being force fed. But there is a lack of positive appetite although as I say, he has eaten something.
I didn't think about the element of inflamation - thank you for that observation Omi. Any invasive procedure will generate some inflamation of tissues particularly when one is taking bits from the intestines (appendix) and opening the stomach. So I will raise this issue with the vet at tea time as I think this is very interesting.
JAne, I will also mention about oral colostrum - whatever that is.
Leo's still lying quite flat and any time he moves I think he is in discomfort and pain. I have spent all the time I can just with him, sitting next to him and stroking him and brushing him but I can't help but ask myself "am I expecting too much"?
Looking at Leo now and his welfare, I am very much of the view that when we take him back at 5pm, I feel I should suggest that they keep him in the hospital. As far as I can see from observing him, I feel that a night here in the kitchen diner, even if it will be with Flo, would not aid his recovery sufficiently. At least in the hospital, despite the rather sterile and unfamiliar surroundings, he can have constant meds if he needs it.
That said, he needs to be home as he can't stay in the hospital for any great length. I am just very confused and very concerned and want what is best for Leo and his recovery. I keep telling myself it's only 3 full days post op and it was such a major op, maybe I am expecting too much too soon? It's just really hard emotionally seeing Leo in this recovery.
Craig xx

 

[*lily*]

Thank you Omi and Jane. I'll be honest with you both - this is emotionally hard on me. Not to take anything away from Leo, because this is his body and his recovery, but watching him like this is as hard if not harder than worrying about him when he was at the hospital. And I've worried non stop because I so desperately am hoping and praying he can pull through. There;s little I can find on the internet regarding what is 'normal' for recovery times other than post op neutering which seems to indicate males recover 24/48 hours after and are generally fine. This however is not comparable to a neuter.
There's no poop from him in the time he's been here. He's nibbled a bit of parsley, had a bit of carrot top and 4 leaves of dandelion. His eating was slow with the parsley and carrot but did seem to be quicker with the dandelion. If you try to put more food down for him, he just gets up and moves away as if he's saying "no thanks" so it's hard to find that balance between getting him to eat but not forcing it. The vet was clear this morning she didn't want him being force fed. But there is a lack of positive appetite although as I say, he has eaten something.
I didn't think about the element of inflamation - thank you for that observation Omi. Any invasive procedure will generate some inflamation of tissues particularly when one is taking bits from the intestines (appendix) and opening the stomach. So I will raise this issue with the vet at tea time as I think this is very interesting.
JAne, I will also mention about oral colostrum - whatever that is.
Leo's still lying quite flat and any time he moves I think he is in discomfort and pain. I have spent all the time I can just with him, sitting next to him and stroking him and brushing him but I can't help but ask myself "am I expecting too much"?
Looking at Leo now and his welfare, I am very much of the view that when we take him back at 5pm, I feel I should suggest that they keep him in the hospital. As far as I can see from observing him, I feel that a night here in the kitchen diner, even if it will be with Flo, would not aid his recovery sufficiently. At least in the hospital, despite the rather sterile and unfamiliar surroundings, he can have constant meds if he needs it.
That said, he needs to be home as he can't stay in the hospital for any great length. I am just very confused and very concerned and want what is best for Leo and his recovery. I keep telling myself it's only 3 full days post op and it was such a major op, maybe I am expecting too much too soon? It's just really hard emotionally seeing Leo in this recovery.
Craig xx

Yes he has had a super huge operation and healing will take a while. I’ve had Does spade and they have taken a few days to start feeling a bit better and a couple of weeks to be back to normal.

I’m sure you are desperate for him to be his normal self again, anyone would be, but it will most likely be a few weeks before you see huge improvement.

Hugs to you all xxx


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[InspectorMorse]

Well here are my thoughts based purely on my interpretation of the information you have posted here. The Surgery Leo has had is probably one of the most major types of GI tract surgery, far greater than the ‘milking’ of a blockage through the intestines. Any surgery on the GI tract of a Rabbit is fraught with possible complications, more so the more the intestines have to be handled. It is not ‘just’ the post operative pain, but the fact that the innervation of the GI tract may be disrupted by the handling of the intestines during surgery. Peristaltic contractions of the intestines may not re-establish = gut stasis. The longer the GI tract is in stasis the more damage is done to the Liver ( hence my question re another blood profile) . Gut stasis and a lot of analgesia that is metabolised by the Liver= not a great scenario. Another possible complication of any abdominal surgery is the formation of adhesions. The way in which a Rabbit metabolises calcium makes them very prone to adhesions after abdominal surgery, especially if the surgery is protracted. Some Vets will give a calcium channel blocker to try to reduce the risk of post surgical adhesions.

Like Omi I was very surprised that Leo has been allowed home. Not because of any doubts about your competence in monitoring him, but because he has had such major surgery and is still in a very, very vulnerable condition. In my unqualified opinion being moved back and forth from Vets to home could be counterproductive. I understand the reasoning of wanting him to be in a more normal environment. But the stress of all the chopping and changing is not something I would consider to be helpful.

Please don’t see this as any criticism of you or of your Vet. My thoughts are just my personal opinion . I really hope this reads as I intend it to and that I am not causing you additional distress.

I do hope that Leo can recover, but I think he may have a very long way to go yet.

 

[Craig 1965]

Jane - thank you so much for this. I am comforted in some ways by your analysis - especially the last part.
In my opinion, I think what the last 2 days of visits were about were more spiritual and emotional well-being for leo. His world dissapeared without warning last Tuesday and to him his life is now in a strange hospital and his body doesn’t feel as it did a week ago. He can move - but I think it’s causing him discomfort and using up the small energy he has. He’s eating but not with appetite but hopefully going in to him should help with getting the gut moving.
He has had a lot of meds so I’ll discuss these with the vet in the next hour.
I sort of see it from both sides - this is his home and his world but I feel he needs that medical support.
I’m just scared more than anything.
Craig xx

 

[susie bun]

Keeping up vibes from Bertieville. I don't have the experience of others but it doesn't seem surprising that eating and pooping are slow to be re-established after major surgery. Take care and sending supportive thoughts. xx

 

[InspectorMorse]

Jane - thank you so much for this. I am comforted in some ways by your analysis - especially the last part.
In my opinion, I think what the last 2 days of visits were about were more spiritual and emotional well-being for leo. His world dissapeared without warning last Tuesday and to him his life is now in a strange hospital and his body doesn’t feel as it did a week ago. He can move - but I think it’s causing him discomfort and using up the small energy he has. He’s eating but not with appetite but hopefully going in to him should help with getting the gut moving.
He has had a lot of meds so I’ll discuss these with the vet in the next hour.
I sort of see it from both sides - this is his home and his world but I feel he needs that medical support.
I’m just scared more than anything.
Craig xx

Being scared is completely understandable x

 

[Pets mum]

Sending more vibes and hugs Craig, Leo is in very safe hands, both with your vets and with you and I'm sure he knows you are all trying to help him x

 

[Craig 1965]

Update at 6:30pm.
I appologise everybun - I seem to be swinging from one way to another and everyone is giving me such wonderful advice and I assure everybun that I am using that advice when I speak to the professionals. I have just got off the phone to the night vet nurse. And this is where we are - having had a much more detailled discussion.
Leo is constantly being assessed on a pain score. I'd been told this over the last few days - and because my memory is failing me more and more now, I had forgotten to ask the vets how a pain chart is used on a rabbit - given that they don't vocalise. I know I sound stoopid but I was very intrigued as to how this worked.
The vet nurse said they use something called the grimmase scale. This was developed by some very clever professionals using some simple observation analylitics. They look at the nose, the eyes, ears etc. It uses images on a chart (apparently you can google it)Don't ask me how this works - I'm not and never will be a professional (I wish I was).
Anyhoo, yesterday when I returned Leo after his afternoon with us, his pain score was assessed as 2, with zero being the lowest and 2 being the highest. I drew some small crumb of comfort from that but the vet nurse said today when we took Leo back at 5pm, his score was now assesed as 1 - which is incredibly comforting. This indicates that there is still some pain of sorts (again, understandable), but that it is assessed as subsiding. I do not pretend to know why this is - people far more experienced than I can educate me on this.
The vet nurse indicated that this is very positive for Leo based on this. I am comforted by that. She said that Leo was observed as being active when we returned him - keen to move round the carrier to the accommodation he is in. She said that whilst he can move in his 'temporary home', it is not ideal and that his recovery and more importantly his gut movement will benefit enormously from moving, no matter how small that is. Movement encourages the guts to move - so I am informed.
The vet nurse assured me that if it was our decision to leave Leo at the hospital tonight, this is absolutely fine, but that it is the view of those looking after Leo that he would benefit hugely from being here as he has space and freedom.
This places me in a dilema and weighs heavily on my already stretched emotions. I was quite upset when we came home at 5:15 without Leo but I also want him to recover, but I also want to heed the advice of the professionals who have in my view been outstanding so far.
The nurse said that my observations that Leo ate more in the afternoon (4 dandelion leaves isn't exactly huge but it was more than he ate when he came home at 10am), and that this means he was feeling more comfortable. She observed that Leo had also given her another bum nugget when she took his temperature. The way she broke that news I thought she was building me up for a bad news episode. His vitals are all good.
Now, the meds. the specialist vet has insisted that he is not to have any IV fluids or meds tonight - whether he is at the hospital or not. So he has been given meds via injection. I know Jane will be interested in this part so this is for you Jane. Leo is on anti vomiting got meds (we didn't catch the name but the vet explained rabbits don't vomit but this med was for his gut we think). Then he's got paracetamol, 2 lots of abx and emipred which is for the guts. My wife is saying metsmytamol (which I'm being told was an abx but I can't for the life of me confirm that). I asked if any of these clashed with gut stasis or anything and I was assured no. So I am confident that the cocktail of meds is assiting him. He is due another paracetamol at 11pm but this would normally be at 1am, however they can bring it forward if we are bringing Leo back tonight.
She said Leo was presenting as lying flat out, chilled and comfortable. No indication of discomfort.
It is complex - or at least it is for me. I'm struggling to process things now, because I want what is best for Leo, not whats best or convenient for me.
It is the view of those professionals that Leo would benefit from being here tonight and tomorrow he would return to the hospital for further assessment all day (we are both at work).
Whilst this is going to be a very long night for me (I'm usually in bed by 8pm cause I'm up at 5:30am), we have agreed to bring Leo back tonight at 11pm. I will prepare the living room and I will sleep down here on the sofa. Leo and flo will have free roam of both the kitchen/diner and the living room and the house will be warm. I will take him back at 8am tomorrow morning and he will see the exotic specialist for an update.
I'm trying to do right as best I can. The vet nurse did say that the reason Leo may have been not as active here today (and yesterday) could be because it now feels slightly odd to him even though he's been here 2 years. It would feel strange to him. I can see where she is coming from. Leo is also going to have his ear catheter removed so I am sure he will feel more balanced and comfortable.
I'll not update anymore tonight. I've got a long evening and I might try to get some zeds but I doubt it.
I will update you all tomorrow.
Thank you for all your advice and input and vibes.
Craig xx

 

[bunny momma]

Thank you for writing the update on Leo.
You are giving this plenty of thought and made an appropriate plan with your professional team.
I certainly understand wanting him to eat on his own instead of force feeding-though syringe feed does not need to be forceful. Perhaps they do not want his stomach to get too full so soon after surgery or want to encourage Leo to eat when he is hungry.
Are they still giving fluids sub q with catheter removed?
Sending lots of vibes that Leo continues to progress. IMO his baby steps forward will become larger steps as he recovers.

 

[joey&boo]

Topping up the vibes & wishing everybun a good night

 

[InspectorMorse]

The anti vomiting med is the Emeprid (Metoclopramide). It increases the rate of gastric emptying. I am assuming there is a good reason not to have him on Cisapride too. This is another gut motility med and works on the lower GI tract. Metoclopramide just works on the stomach.

My Vet was one of the Professionals who put together the Rabbit Grimace Scale

I hope that Leo has a comfortable night x

ETA - the antibiotic is probably Metronidazole

 

[tonibun]

This must be horrendously stressful for you and your wife. I hope you manage to get some sleep tonight.