Acute bloat/hypomotility of the gut? Updated: Confirmed arthritis

Thank you Gemmapookie and thumps for your good wishes.

Currently sat here thumb twiddling and finger drumming... can't pick them up til 6.20pm and desperate to get them both home and eating properly.

Unfortunately vets had several emergencies and theatre time was pushed back, I was expecting to get the phonecall between 1-3pm, but as had heard nothing I rang at half 3. Nino was only just going in for his Xray!:shock: I expect my vet has been rushed off his feet poor man. These things happen, but I am extremely worried now about how much they have both eaten all day. Poppy won't eat if she's stressed, and am a bit worried about Nino too... he needs prompting at the moment and I doubt anyone has had time, which means he's probably had his GA on an empty tum and I might end up with two buns in ileus/stasis tonight...arrggh! I really hope they have both been eating. They had a room to themselves and their litter tray and hay etc... so fingers crossed they had some peace and quiet to be calm enough to eat. I hope i'm worrying unnecessarily.
The phonecall to say come and collect obviously means he is ok and survived his GA which is great.

Great news that the GA went well.
Now everything crossed for the XR results & well behaved tummies.
Come on Nino & Poppy eat & poop for RU.

We're home and both of them are fine. Was expecting a heavily sedated bunny, shows my experience of modern GA's in rabbits! Instead we got a wide awake bunny digging for Australia in his carry cage, and one very fed up Poppy bunny. They did however do fine in their 'private suite' at the vets! :lol: Apparently most of the time was spent side by side in their litter tray.

Nino is tucking into food and has already pooped and weed, Poppy is getting there, I don't think she is ill, she is just very scared after a day of stress, she has coped amazingly well considering what a nervous bun she is. They've had a quick hop in the garden to stretch legs but nothing more, Poppy is not in the mood and Nino is still post GA. The only thing she wanted to eat was our little willow tree.... so we let her. Nino had a good graze and hop. Both tucked up now with veggies and peace and quiet.

Well, Xrays were not as bad as we thought. Much clearer Xrays from a more modern machine I guess, and of course a better position with him anaesthetised. I requested some skull ones just to rule stuff out - his tooth roots are perfect, am so thrilled about that. Vet said his spurs were really tiny when he got to see them properly at last... and only on his lower teeth, his top teeth have no spurs. :thumb: They really were nothing to worry about, but he burred them off anyway whilst he was there. So i'm satisfied it is not his teeth and so happy all is normal. This hay only diet has really managed his mild malocclusion wonderfully - good timing and a bit of luck.

His hips show a lot less arthritic changes than we, or the vet, were expecting, nothing really to worry about in that respect we hope. The femoral heads do still look an odd shape but our vet is wondering if this is a normal presentation in some rabbits... he is not sure and is going to send the Xrays off to a few people to find out. If anyone knows an exotics vet with a speciality in orthopaedics please let me know! My vet is sending me the Xrays too so I can also forward them on to anyone I know.
The only concern was a spot of spondylosis at the lumbar/sacral vertebral junction. Again, this could be normal for some buns or a bun of his age (4)? and we do not know if this could be sufficient to be causing his recurrent bloat/pain/stasis episodes, another one for the orthopaedic specialist if we can find one.
The rest of the Xray was normal - no stones, masses, etc... so happy to see that really, the puzzle is now what is causing his episodes. We are going to now try removing the maxolon and zantac (after tonight - he will need it post GA) and only give him meloxidyl daily instead, to eliminate pain from the equation... sort of a trial and error to find what the underlying cause relates to really.

I'm thrilled that all went well at the vets, & hope that they carry on eating, especially Poppy.

I think that you'll need a good rabbit orthopaedic specialist to interpret those films. The only thing which makes sense to me as a non vet, is the touch of spondylosis (joint wear arthritis in the spine) at the lumbo sacral junction. (where the spine reaches the pelvic bones). I think that this could account for the discomfort When Nino stands on his hind legs & his stretching.

I can only find this slow motion of a rabbit running, starting at 1:30
http://www.youtube.com/watch?v=Iic2IJovJ38
They need so much mobility at the lumbo/sacral junction when you think of the range of movement from sitting to running & the back is almost acting like a spring.
I've no idea whether this could be sufficiently significant to cause Nino's bloat though.
It may also be worth asking whether buns can have glucosamine (extracted from green lipped mussles). It's done wonders for my knee caps. (chondromalacea patellae)

ETA chibudgieluvr's videos are lovely, but I don't look at the others - some are nasty!!

Aww Judy what a lovely video clip! They don't look like our wildies... are they cottontails?
I can see though from the slow motion pics that the lumbar-sacral region is taking a lot of wear from that high jumping hop - almost like an overextension of the spine, what amazing creatures bunnies are. Yes this is exactly how Nino hops when he is in a bouncy mood - he does take these great leaps just like in the video. Poppy moves quite differently.
This area of calcification on his Xray could certainly explain the temporary lower back/hip stiffness after periods of sitting still and his rigidty and arching when being made to extend his spine on the consult table.

Mr PL has done some googling and found quite a few people who use glucosamine for arthritic rabbits - so it is a possibility... might ask our vet next time we see him. I am encouraged that our vet is as keen to find the cause of Nino's bloat as we are, he's very interested in our rabbit, and so very kind, we are lucky to have a vet who is proving to be extremely willing and supportive.
(p.s. Poppy is looking much happier and has done some more droppings Nino is busy washing himself using his bowl of water... it's his new thing. I squirted his fibreplex out the side of his mouth (i'm tired tonight) and he is making very sure he doesn't miss an ounce off his dewlap! :lol

I'm glad the ga went well and the xrays did not show any major cause for concern.
Thumps makes an excellent suggest re trying glucosamine- it is used quite quite often in cats and dogs but I am not sure of a 'dose rate' for rabbits- hopefully your vet will be able to advise. If you don't fancy feeding your rabbit green-lipped mussel there are vegetarian ones available for humans

Sorry to have missed all this and I am glad Nino is back home now.

When he gets these 'episodes' is the pain in his small intestines ?

Do they fill with gas pockets or does his actual stomach bloat up ?

Jack's-Jane said:

Sorry to have missed all this and I am glad Nino is back home now.

When he gets these 'episodes' is the pain in his small intestines ?

Do they fill with gas pockets or does his actual stomach bloat up ?

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Thank you Jane, and no worries, you have had poor Sir Victor on your mind I know.

His stomach bloats up, both myself, Mr PL and many different vets have all agreed, but some have also identified gas pockets in his intestines, and an Xray on an emergency occasion has confirmed these. Even though the cranial section of his abdomen becomes distended and bloated, I find whilst massaging that he is most tender distally and he will flinch and bite, then as the massage shifts what we assume are lower gas pockets the flinching disappears and he starts to lick instead, it is very sweet.
He usually deteriorates very quickly despite immediate medicating at home, prokinetics, pain relief (top dose) infacol and oral fluids and can present an hour later at vets dehydrated and in a lot of pain On one occasion he was quite moribund and heavily dehydrated, even though there was NO obvious symptoms until the display of abdo pain and refusing food, we have been lucky enough to be at home every time and catch it instantly. He must hide a great deal. At other times he will respond very quickly to his meds and be back to normal without need for emergency treatment - sadly these occasions are less common now.

He displays abdominal pain symptoms of pushing his belly to the floor and stretching his tummy out and refusing food, it can happen very suddenly, after/during eating, during hopping/after snoozing. He sometimes has slowdown and a change in faecal output beforehand, volume and size, and other times not. There is an ongoing faecal pattern disruption he gets despite ongoing prokinetics, generally each morning after normal droppings early, he will pass some teeny tiny ones (seed bead size) late morning, then by the afternoon they will steadily increase in size again to Poppy sized ones. He appears to get slowdown when he takes rest. The last two episodes of abdo pain and refusing food occurred instantaneously after straining for a wee - there was no bloating on these occasions and he responded immediately to NSAID's.
After 3-4 days of metclopramide droppings tend to stay a constant volume and size, but 2-3 days after finishing the course he tends to have another episode.
When the guts get moving again, he will pass some left over normal faeces first from his descending colon and then the rehydrated oddly shaped bits and pieces of what was clearly a very dried up impaction of ingesta passes out. (on the bad occasions this is)

Any ideas? We and our vets are stumped.

Glad the GA went well and the xrays ruled out anything overly significant with his bones. What a fantastic vet you have, such a devoted and caring vet is what most of us can only dream of! I hope the rest of ur mission to find out whats causing ninos episodes is successful and reveals something you can manage easily xxxxx

prettylupin said:

Thank you Jane, and no worries, you have had poor Sir Victor on your mind I know.

His stomach bloats up, both myself, Mr PL and many different vets have all agreed, but some have also identified gas pockets in his intestines, and an Xray on an emergency occasion has confirmed these. Even though the cranial section of his abdomen becomes distended and bloated, I find whilst massaging that he is most tender distally and he will flinch and bite, then as the massage shifts what we assume are lower gas pockets the flinching disappears and he starts to lick instead, it is very sweet.
He usually deteriorates very quickly despite immediate medicating at home, prokinetics, pain relief (top dose) infacol and oral fluids and can present an hour later at vets dehydrated and in a lot of pain On one occasion he was quite moribund and heavily dehydrated, even though there was NO obvious symptoms until the display of abdo pain and refusing food, we have been lucky enough to be at home every time and catch it instantly. He must hide a great deal. At other times he will respond very quickly to his meds and be back to normal without need for emergency treatment - sadly these occasions are less common now.

He displays abdominal pain symptoms of pushing his belly to the floor and stretching his tummy out and refusing food, it can happen very suddenly, after/during eating, during hopping/after snoozing. He sometimes has slowdown and a change in faecal output beforehand, volume and size, and other times not. There is an ongoing faecal pattern disruption he gets despite ongoing prokinetics, generally each morning after normal droppings early, he will pass some teeny tiny ones (seed bead size) late morning, then by the afternoon they will steadily increase in size again to Poppy sized ones. He appears to get slowdown when he takes rest. The last two episodes of abdo pain and refusing food occurred instantaneously after straining for a wee - there was no bloating on these occasions and he responded immediately to NSAID's.
After 3-4 days of metclopramide droppings tend to stay a constant volume and size, but 2-3 days after finishing the course he tends to have another episode.
When the guts get moving again, he will pass some left over normal faeces first from his descending colon and then the rehydrated oddly shaped bits and pieces of what was clearly a very dried up impaction of ingesta passes out. (on the bad occasions this is)

Any ideas? We and our vets are stumped.

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Well according to FHB some 'stasis/bloat prone' Rabbits *might* have an abnormality in part of their small intestines. A 'structural' problem which she has encountered during laparotomy or a PM.
AFAIK she has successfully found and removed the 'damaged' part of the guts in some Rabbits and this has cured the recurrent GI tract problem.

Maybe your Vet could fax FHB (I think she only responds to faxes now and not emails/phone calls )

Obviously exploratory surgery would be a last resort but I dont think said 'structural problem' could be identified from Xrays or U/S.

Jack's-Jane said:

Well according to FHB some 'stasis/bloat prone' Rabbits *might* have an abnormality in part of their small intestines. A 'structural' problem which she has encountered during laparotomy or a PM.
AFAIK she has successfully found and removed the 'damaged' part of the guts in some Rabbits and this has cured the recurrent GI tract problem.

Maybe your Vet could fax FHB (I think she only responds to faxes now and not emails/phone calls )

Obviously exploratory surgery would be a last resort but I dont think said 'structural problem' could be identified from Xrays or U/S.

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Thank you Jane, yes I had heard this and have already asked my vet about it, isn't it something like an acute angle at the ileo-caecal junction? Like you he said the only way to tell would be to do a laparotomy, not something I think we would want to do to be honest. I have heard GI surgery on rabbits is pretty risky?
But thank you for your thoughts, it is certainly something that regularly crosses my mind. I'm hoping it is something easier to treat!

(ETA I think we are contacting GWR for now...) But I will bear FHB in mind also, thank you.

prettylupin said:

Thank you Jane, yes I had heard this and have already asked my vet about it, isn't it something like an acute angle at the ileo-caecal junction? Like you he said the only way to tell would be to do a laparotomy, not something I think we would want to do to be honest. I have heard GI surgery on rabbits is pretty risky?
But thank you for your thoughts, it is certainly something that regularly crosses my mind. I'm hoping it is something easier to treat!

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I have found that with Dermot (who appears to have a similar problem to Nino) Metoclopromide actually exacerbates the problem :? He does much better on just Ranitidine, SQ and oral fluids and an opiate (by injection) for analgesia.
Also, if he ever has a really bad episode causing a true bloat then Buscopan has been a life saver.

Jack's-Jane said:

I have found that with Dermot (who appears to have a similar problem to Nino) Metoclopromide actually exacerbates the problem :? He does much better on just Ranitidine, SQ and oral fluids and an opiate (by injection) for analgesia.
Also, if he ever has a really bad episode causing a true bloat then Buscopan has been a life saver.

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That's really interesting and odd because Nino improves significantly with metclopramide whereas ranitidine appears to do very little for him :? I have never tried buscopan, I have asked, but our clinic doesn't seem to use it as far as I am aware. Nino can't really tolerate the opiates at all, or very little, so we tend to use more NSAID instead. It's all very odd :? But thank you and poor Dermot too

Sometimes I feel like it's one thing after another with bunnies :roll:

Poppy still isn't eating her usual amount or up to her usual level of activity but she is eating and pooping and is moving around almost as normal. She has sneezed and washed her nose a bit more than usual and just now she sounded a bit snuffly - put the light on in the hutch and she is a bit damp around her nose. What's the chances of a sub-clinical 'snuffles' brought on by stress from the vet trip yesteday? I'm thinking quite likely. There's no pus and she's not sneezed since this morning, I've always suspected something 'under control' with both my buns in terms of URTI anyway, so hoping with plenty of rest, exercise, good food and some echinacea in the water we can get her back on top of it.

prettylupin said:

Sometimes I feel like it's one thing after another with bunnies :roll:

Poppy still isn't eating her usual amount or up to her usual level of activity but she is eating and pooping and is moving around almost as normal. She has sneezed and washed her nose a bit more than usual and just now she sounded a bit snuffly - put the light on in the hutch and she is a bit damp around her nose. What's the chances of a sub-clinical 'snuffles' brought on by stress from the vet trip yesteday? I'm thinking quite likely. There's no pus and she's not sneezed since this morning, I've always suspected something 'under control' with both my buns in terms of URTI anyway, so hoping with plenty of rest, exercise, good food and some echinacea in the water we can get her back on top of it.

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*sigh*..................

I think some Buns sneak online to research how best to stress their hoomins !!

I hope Poppy is just a bit sniffy and that nothing more developes.

Jack's-Jane said:

*sigh*..................

I think some Buns sneak online to research how best to stress their hoomins !!

I hope Poppy is just a bit sniffy and that nothing more developes.

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:lol: I think your lot must have their own laptop Jane!

Thank you, me too. She seems ok this morning, will keep an eye on her.

Any news about your buns? How are they?

Just for anyone who has been interested in this thread, and because I feel this might be quite an important finding in terms of recurrent bloat/stasis in the older rabbit for which owners may not have an answer.

Nino's Xrays were sent to a 2nd referral clinic for interpretation, GWR, who gave us a much more thorough and detailed report and have confirmed that he has some signifcant arthritic changes to both his hip and knee joints, certainly more than sufficient they say to be responsible for his recurrent bloat/stasis episodes that have increased in frequency astoundingly this year. This would make sense considering the very cold winter we experienced, and the progressive nature of arthritis.

Nino will be on daily NSAID now for the rest of his life . Up until today he was doing very well for the last two + weeks with no bloat flare ups... but this morning he lost his appetite very suddenly and his faecal output this morning was pretty non-existant. It appears the very low maintenance dose of metacam we have been giving him is not controlling his pain so we will no doubt have to increase this in the acute phase.
He also did two high speed laps of the garden last night - faster than we've seen him run for some time, perhaps he made his hips sore again! :roll: He's always a very active rabbit - constantly on the move and binkying! You just wouldn't know he had such degeneration in his joints except for momentary stiffness after he has been sat around. He's only 4 after all. We hope that we can manage his pain and control his bloat that way, and make adaptations to our house (when we manage to buy it!) to accomodate all his needs for now and the future. We are a bit sad that he has this so young I don't like to think about the future.

Just goes to show how important further investigations can be. If our vet had not requested that old Xray from an emergency clinic to check for Kidney/bladder stones and other anomalies he might never have spotted Nino's funny bones and we may not have had an answer to his recurrent bloat/stasis. For this I am very grateful

Thank you for updating us pretty lupin.
I sincerely hope that the NSAIDS will improve Nino's quality of life by reducing the pain from his joints & from his bloat episodes.

I hope you may also consider the use of glucosamine, which certainly delays the arthritic process in many humans, & improves the lubrication properties of the synovial fluid.

Everything crossed for you all.

Thats really interesting and I hope that Nino will remain comfortable now you have some answers

It is amazing the symptoms that arthritis can cause. We had an elderly incontinent rabbit and we tested kidneys, EC all the usual stuff. It turned out that she had severe arthritis in her spin that was pressing on the nerves affecting her bladder