Recurrent stasis- thoughts on possible causes? Diagnosed hepatic coccidiosis - FIXED

[auburnette]

I never knew that about the rabbit colouring. My only stasis rabbit (occasional and mild) is a white butterfly marked with agouti buck.

Yep, same for Honey.

 

[MightyMax]

I've just gone back and re-read your original message and highlight this:


Both bunnies have outside access and are up to date with all vaccines (combo myxi/RHD and RHD2, which they were vaccinated for about 3 weeks ago).

I know the stasis is recurrent, but could the vaccinations have perhaps played a part in this instance? Was there a gap between the two vaccinations and if so, how long was it?

Sorry if you've been through this already .. Just my little head thinking!

 

[auburnette]

Update - Honey not right again this morning after being fine last night but we have been able to get her eating again within a few hours with metacam, emeprid, a syringe of Recovery and some snuggles with Treacle. Because it's recurred so quickly again this time we are thinking the underlying pain or whatever it is must still be present (she's been on Baytril since last week). She is very interested in hay now. Maybe teeth are more of a possibility after all...

We made an appointment with Trinity vets for 3pm but Mark isn't available today, is it worth waiting for an appointment with him? (she is probably OK for today now and we are going to continue with Metacam/Emeprid every day until we find the cause)

Re vaccinations the gap was about 6 months as we did the combo vaccine in Feb and she had RHD2 vaccine about a month ago.

There have been fireworks nearby recently but both rabbits didn't seem bothered (they are used to loud noises as they live right by the kitchen/living room)

 

[MightyMax]

Update - Honey not right again this morning after being fine last night but we have been able to get her eating again within a few hours with metacam, emeprid, a syringe of Recovery and some snuggles with Treacle. Because it's recurred so quickly again this time we are thinking the underlying pain or whatever it is must still be present (she's been on Baytril since last week). She is very interested in hay now. Maybe teeth are more of a possibility after all...

We made an appointment with Trinity vets for 3pm but Mark isn't available today, is it worth waiting for an appointment with him? (she is probably OK for today now and we are going to continue with Metacam/Emeprid every day until we find the cause)

Re vaccinations the gap was about 6 months as we did the combo vaccine in Feb and she had RHD2 vaccine about a month ago.

There have been fireworks nearby recently but both rabbits didn't seem bothered (they are used to loud noises as they live right by the kitchen/living room)

I would definitely wait for Mark if she's doing OK at the moment.

Perhaps this stasis was due to the RHD2 Vaccine? Just wondering what possible causes might be/have been ...

 

[Jack's-Jane]

Update - Honey not right again this morning after being fine last night but we have been able to get her eating again within a few hours with metacam, emeprid, a syringe of Recovery and some snuggles with Treacle. Because it's recurred so quickly again this time we are thinking the underlying pain or whatever it is must still be present (she's been on Baytril since last week). She is very interested in hay now. Maybe teeth are more of a possibility after all...

We made an appointment with Trinity vets for 3pm but Mark isn't available today, is it worth waiting for an appointment with him? (she is probably OK for today now and we are going to continue with Metacam/Emeprid every day until we find the cause)

Re vaccinations the gap was about 6 months as we did the combo vaccine in Feb and she had RHD2 vaccine about a month ago.

There have been fireworks nearby recently but both rabbits didn't seem bothered (they are used to loud noises as they live right by the kitchen/living room)

The other Vets at Trinity are good too, so if Mark is not going to be available for several days personally I'd take Honey in to see one of Mark's colleagues. They can always contact him for advice if needs be.

 

[auburnette]

We managed to get a slot with Mark, very impressed. He even waited for the results of her blood test to be sent through and we were in there a good hour! He thinks the profile of her white blood cells does suggest an infection (or at least a primary inflammatory response) and has switched her from Baytril to an antibiotic that deals with anaerobic bacteria. He agreed with the milk thistle and gave her various things to support her liver function as well as prescribing a massive 32 ml Metacam (our normal vet wouldn't prescribe excess). He was really impressive and we're feeling hopeful we're much closer to identifying and ideally addressing the cause. She will go back for a followup next week, in the meantime back on the metacam, gut drugs, milk thistle, new antibiotic and recovery feed. It was very reasonably priced too for the massive bag we came away with!

 

[Jack's-Jane]

We managed to get a slot with Mark, very impressed. He even waited for the results of her blood test to be sent through and we were in there a good hour! He thinks the profile of her white blood cells does suggest an infection (or at least a primary inflammatory response) and has switched her from Baytril to an antibiotic that deals with anaerobic bacteria. He agreed with the milk thistle and gave her various things to support her liver function as well as prescribing a massive 32 ml Metacam (our normal vet wouldn't prescribe excess). He was really impressive and we're feeling hopeful we're much closer to identifying and ideally addressing the cause. She will go back for a followup next week, in the meantime back on the metacam, gut drugs, milk thistle, new antibiotic and recovery feed. It was very reasonably priced too for the massive bag we came away with!

So glad that you did get to see Mark. The Man is a genius !! His advice has saved the life of two of my Rabbits. Is the new antibiotic called Metronidazole ?

Sending lots more vibes for Honey x

 

[MightyMax]

We managed to get a slot with Mark, very impressed. He even waited for the results of her blood test to be sent through and we were in there a good hour! He thinks the profile of her white blood cells does suggest an infection (or at least a primary inflammatory response) and has switched her from Baytril to an antibiotic that deals with anaerobic bacteria. He agreed with the milk thistle and gave her various things to support her liver function as well as prescribing a massive 32 ml Metacam (our normal vet wouldn't prescribe excess). He was really impressive and we're feeling hopeful we're much closer to identifying and ideally addressing the cause. She will go back for a followup next week, in the meantime back on the metacam, gut drugs, milk thistle, new antibiotic and recovery feed. It was very reasonably priced too for the massive bag we came away with!

I am so pleased you got to see Mark - I felt it was worth holding out for him

What other things did he recommend to support her liver function alongside the milk thistle?

 

[auburnette]

He recommended aggressively feeding (get as much into her as possible) to help limit any damage caused by hepatic lipidosis as a result of the stasis and gave a steroid injection to encourage her to eat. We've got a big box of Excel recovery pellets. We also got a bottle of a product they sell to support liver function, which contains milk thistle amongst other things. Sadly she hates it but it's a syringe job anyway!

Re the antibiotic I can't remember the name offhand, it contains half trimethoprim half something else.

She gave me a good fright today as she strenuously resisted syringe feeding and leapt off my partner's lap part way through - not very high at all, he was kneeling on the floor, but then was very angry at us and turned up her nose at all peace offerings. We have a webcam for the bunnies and I've seen her nibbling on hay earlier but both bunnies like to mainly sleep during the day out of view of the webcam so of course I have been worried about her. :roll: She's just had a grooming session and is now back in standard loaf position, so i think she's okay - would prefer it if she would oblige and eat a load of hay on webcam though!

 

[MightyMax]

He recommended aggressively feeding (get as much into her as possible) to help limit any damage caused by hepatic lipidosis as a result of the stasis and gave a steroid injection to encourage her to eat. We've got a big box of Excel recovery pellets. We also got a bottle of a product they sell to support liver function, which contains milk thistle amongst other things. Sadly she hates it but it's a syringe job anyway!

Re the antibiotic I can't remember the name offhand, it contains half trimethoprim half something else.

She gave me a good fright today as she strenuously resisted syringe feeding and leapt off my partner's lap part way through - not very high at all, he was kneeling on the floor, but then was very angry at us and turned up her nose at all peace offerings. We have a webcam for the bunnies and I've seen her nibbling on hay earlier but both bunnies like to mainly sleep during the day out of view of the webcam so of course I have been worried about her. :roll: She's just had a grooming session and is now back in standard loaf position, so i think she's okay - would prefer it if she would oblige and eat a load of hay on webcam though!

Could be Trimethoprim/sulfamethoxazole? Otherwise known as Trimethoprim Sulfa

 

[thumps_]

Aubernette I wonder if you can get hold of some forage to encourage her to start eating? Sadly I can't predict what she'll take to, but in common they're all high in woody fibre which seems to be essential to restart a rabbit in stasis. There are apple leaves & fresh twigs, bramble leaves, willow leaves & fresh twigs (usually grow near water)
Perhaps the most significant post is towards the end - Marie Kubiac, another remarkable rabbit vet was converted to this approach when she used some of Thumpers forage on a hospitalised rabbit who'd been in stasis for over 5 days & not responding to any treatment. Thereafter she used this type of forage for all buns at risk of stasis, or in stasis at the hospital.
I knew all the rabbits on the thread very well, & every one presented major problems with frequent & recurrent stasis, or slow down. The thread was made in the early days of using this method to restart a rabbit's gut, always in conjuction with standard drug treatment. Our success rate at the time was 100% I don't know how many people use it now.
http://forums.rabbitrehome.org.uk/s...ried-given-your-stasis-prone-buns-tree-leaves
This is the link I recommend

They can be bought on the internet Galen's garden is one, or maybe pm Parsnip bun. Blackthorn /sloe leaves are a great favourite also, but difficult to obtain commercially. If you ask the foragers to help by putting up a thread on diet, hopefully you'll get some help.

The drug we're thinking of is also known as Septrin.

 

[auburnette]

It is sulfatrim, yep.

We have access to apple trees and bramble from the allotment and lots of sloes round here too - will try collecting some tomorrow. They occasionally get apple twigs when we trim the trees.

Sadly she had a bit of a wobble today and needed more metacam and the usual drugs, forcefeeding to get her going. I think this was our fault for upsetting her this morning with the meds, we are going to go a bit slower and make sure she's back eating again after them. She is eating well again now though still a bit quiet and not her usual bouncy self - she has had 5 (!) handfuls of recovery and protexin pellets and romaine to wash them down. I wouldnt usually give anywhere near this volume but Mark said it was important to get her into a positive energy balance to undo any liver damage caused by the stasis itself. She is down to 2.08kg from 2.18 earlier in the year.

Hope providing the detail will help anyone with similar problems. I could post her blood panel results as Mark said many vets would miss the inverted white blood cell relationship indicating likely primary infection.

I do hope the antibiotics work soon, she is a good bunny with lots of personality and it's so sad to see her not right

 

[thumps_]

It is sulfatrim, yep.

We have access to apple trees and bramble from the allotment and lots of sloes round here too - will try collecting some tomorrow. They occasionally get apple twigs when we trim the trees.

Sadly she had a bit of a wobble today and needed more metacam and the usual drugs, forcefeeding to get her going. I think this was our fault for upsetting her this morning with the meds, we are going to go a bit slower and make sure she's back eating again after them. She is eating well again now though still a bit quiet and not her usual bouncy self - she has had 5 (!) handfuls of recovery and protexin pellets and romaine to wash them down. I wouldnt usually give anywhere near this volume but Mark said it was important to get her into a positive energy balance to undo any liver damage caused by the stasis itself. She is down to 2.08kg from 2.18 earlier in the year.

Hope providing the detail will help anyone with similar problems. I could post her blood panel results as Mark said many vets would miss the inverted white blood cell relationship indicating likely primary infection.

I do hope the antibiotics work soon, she is a good bunny with lots of personality and it's so sad to see her not right

I'm sorry, I didn't explain how I was thinking properly. Yes, indeed it's important to get energy foods into them.
A big problem in the beginning is that gut movement is still very slow. If it it's slow to come out, they can't eat very much which exaccerbates the slow gut.
Some say that the fibre in eg crtical care isn't the right size to be a good gut stimulant.
So my thinking is to get the gut moving well as fast as poss, then hopefully she'll be able to eat on her own, which avoids her stress of being force fed. (stress can also slow the gut - but in this situation we just have to get on with it) The response is usually very dramatic.
Please don't blame yourself for the downturn today. Even my rabbit vet couldn't force feed Thumper. I was quite relieved when she returned him to me, critical care still in her hair from the attempts! Phew!! I wasn't so incompetant after all!

Great that you've got some stuff on the allotment! Mine both prefer bramble leaves dry, you can put them in the lowest possible oven temp with the door open a crack - they dry quickly. Mine also prefer them to be dethorned but this is not usual. Easiest to dethorn when they're almost dry, Thimble or some clean rag to protect your finger & rub each leaf firmly from tip to base.
Wildies eat fallen sloe leaves - our fresh ones have all fallen now.

Yes, please post the WBC result. If it's written on the form, there may be the range of normal values. Please could you print those as well?
Buns in complete stasis (ileus) should have a low WBC from the stress of the pain. An elevated WBC however small / even top of the normal range should alert us to infection.

With twigs, the smaller bendy ones are best so she can chew the lot. She may not know how to strip the bark from larger twigs. Of course you can always strip the bark off larger twigs for her. There is still some nutrient in the bendy twigs from sap in the cambium (the layer right next to the hard wood).

Bramble leaves have roughly the same nutrient value as hay.

Re leaves- they'll also eat fallen leaves, as long as they haven't started to rot.

All the best. Hoping this does the trick for you.

 

[auburnette]

Cool - I've given them some fresh apple twigs with the leaves attached, both bunnies enjoyed, Honey preferred the leaves to the twig itself. I will give more twigs/leaves and strawberry leaves tomorrow.

I'm just figuring out where to upload the image to and then will post her blood panel results.

 

[thumps_]

Good girl Honey Although the twigs have plenty of fibre the tree leaves have about the same nutritional value as hay as well as good lignin content.
Strawberry leaves have less lignin - but if she goes for them let's just start her eating. Offer a selection & let her choose. (I wouldn't give dandelion leaves just now because they're a diuretic (make bunny wee a lot) & we want her to fill up with food not water!)

Sloe leaves are like gold dust for tummy bunnies. They'll only eat them after the sloes have fully ripened, so the gathering season is short. Please get a stock in while you can. I don't think that Honey needs them now, but they're amazing when the micro organisms in the caecum get out of balance - you'll see uneaten caecotrophs (special poohs) like tiny, soft bunches of grapes if this happens. (Apologies, but when we've had a stasis prone rabbit we get totally obsessed with rabbit pooh)

ETA If you're feeling totally confused about dandelions,etc different parts have different medicinal properties.
The flowers are a mild analgesic.
The leaves are crammed with vitamins & nutrients BUT contain a lot of sap which is the diuretic. It's easier on the rabbit stomach than human veg but needs to be introduced slowly like any new food.
The root helps the liver but also has a lot of sap.

Similarly sow thistle. Only the seeds help the liver.
The leaves have a good nutrient value but no diuretic - otherwise as per dandelion leaves.

 

[thumps_]

How is Honey today?

 

[HannahB]

We managed to get a slot with Mark, very impressed. He even waited for the results of her blood test to be sent through and we were in there a good hour! He thinks the profile of her white blood cells does suggest an infection (or at least a primary inflammatory response) and has switched her from Baytril to an antibiotic that deals with anaerobic bacteria. He agreed with the milk thistle and gave her various things to support her liver function as well as prescribing a massive 32 ml Metacam (our normal vet wouldn't prescribe excess). He was really impressive and we're feeling hopeful we're much closer to identifying and ideally addressing the cause. She will go back for a followup next week, in the meantime back on the metacam, gut drugs, milk thistle, new antibiotic and recovery feed. It was very reasonably priced too for the massive bag we came away with!

Although I can't offer any advice on treatment, I wanted to add another vote of confidence for Trinity. We're based in Tonbridge and had used Sevenoaks Vets (you'll know them I'm sure!) for years. However after our girl got poorly and just wasn't getting any better under their care, we saw Mark and he was *incredible*. Sadlly Miss didn't make it in the end - I think her illness was too advanced and what with her age, she just couldn't be saved. However they gave it their absolute best and I'd never go anywhere else now. Don't panic if you can't get Mark for an appointment - Richard is also utterly brilliant as is Allie. Also, Chrystabel is one of their vet nurses who has a real specialism in bunnies - and has been incredibly generous with her time in helping us and is always happy to give advice over the phone.

Wishing you and your buns all the very best luck

 

[auburnette]

Honey is doing ok bit more lively and feisty than of late, though still not as much appetite as our other bunny ( that's fairly standard...). They had a nice run around in their run today.

Here they are enjoying a naughty treat of stuffed willow bell.

 

[tonibun]

They are enjoying that! Those little pieces aren't bits of corn are they?

 

[auburnette]

No it's marigold, carrot and oat. I've taken it away so they don't destroy it in minutes!