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Gi stasis, how much critical care should I feed?

Yes on the way to the vets I thought it was goodbye, but whilst at the vets she seemed much chirpier and the vets seemed very positive about her chances.

I think the belief is still that the respiratory issues cause the gi stasis, but now her digestive system needs time to recover to get back to normal. They aren't looking for something more sinister as her other symptoms don't really suggest there's much more there. If the glucose came back high they would then have done bloods, but it was normal so they didn't see the need.
 
Aw, that's really good. I'm relieved for her and for you.

Ah, I see. I hope her digestive system recovers soon, then, with more syringe feeding and medication. I wonder why she was doing better, eating her herbs, and now has stopped eating again. Have you been able to get her to take more syringe feeds than you described in your first post? If she's not getting enough food or fluids inside, her guts will really struggle to function.
 
Since wednesday the vets advice was to offer food, and then only give critical care if she ignores the food which is what I've been doing, so I'd really dropped most of the critical care, till had to pick it up again at the weekend.

She can tolerate around 15ml of the critical care at once, and then I also leave some on her dulap and legs, as she will lick it off then and gets a little more that way!
 
New user on here, figured I'd chime in since I have had a lot of experience with GI stasis in my buns (unfortunately) recently.

First off, if she's in pain, rabbits need a very high dose of Metacam compared to other animals to achieve similar blood-plasma concentrations. Dosages under 0.5mg/kg meloxicam are considered practically ineffective in rabbits. With 0.5ml and 2.5kg, your bun was at 0.3mg/kg. Studies have shown that rabbits need ~1.0mg/kg to achieve blood plasma concentrations at which other animals show actual pain relief. Unfortunately, pain cannot be easily evaluated in rabbits since they are prey animals and will hide their pain, so direct effectiveness studies in rabbits do not currently exist.

Fortunately, quantifiable safety studies are possible; long-term studies show rabbits will tolerate 1.0mg/kg of Meloxicam for at least 30 days without side effects or irreversible kidney damage (likely longer, but the research was 30 days). Half-life of meloxicam in rabbits is quite low, about 8 hours, so I default to 0.5mg/kg every 12 hours, occasionally giving 1.0mg/kg if they seem to be in acute pain. Blood plasma levels will not stay high enough for a full 24h. For your bun, this would be 1.66ml of Loxicon (assuming the 1.5mg/ml variant) per 24h. I do believe 0.5ml will have little to no effect, so very good your vet upped it to 1.3ml.

Next up, is she pooping? If she's pooping regularly, she's not in stasis (the gut works) and other options should be considered. Think dental / mouth ulcers. My rabbit was fine and energetic, but didn't want to eat due to an outward hook of her back molar creating a painful ulcer in the mouth that was not easily seen upon initial inspection.

If she's not pooping (or the droppings are extremely small despite force-feeding) and there are no sounds in her stomach, Cisaprid + Emeprid imo is a must. Emeprid works on stomach emptying, Cisaprid is a general GI stimulant that fires up the caecum, colon and to a lesser extent also the stomach. They can have 0.5mg/kg of both, up to 4 times a day(!). My 2.2kg bun got 1ml of each when in stasis. Once the gut is fully active again, they need to be weaned off of this over a period of about a week, gradually lowering frequency and dosage, since these are neurological stimulants - the rabbit's 'brain' needs to take over again when the gut has restarted. I have had a rabbit that had recurring GI due to me stopping too abruptly with these gut stimulants.

In any case, tummy massage has helped me a lot too. This helps physically stimulate the gut / move the contents around and moves any potential gas bubbles. You'll want to try to massage in the direction of the GI tract, gently palpating with your fingers. Your bunny will most likely find it comfortable, if she feels bloated and the massage is painful she will most likely resist. Observe what the bun will tolerate. The direction of massage is starting on the rabbit's upper right-hand side, just behind the ribcage, to under the belly and towards the right-hand-side groin area. From there, with the other hand, massage on the left side starting in her left-hand-side groin up towards her chest/belly on the underside. Work in circles this way. Direction is mostly important in case of gas, since you want to move it towards the end and not back up.

This is now my default protocol, and usually I see improvement within 48h. So, recap:
- Metacam at 1.0mg/kg per 24h
- Cisaprid and Emeprid at 0.5mg/kg 4x a day if necessary (I usually start off with a lower frequency)
- Tummy massage every few hours
- Syringe-feeding every 3-5 hours, about 10ml critical care/kg per session.

(sidenote, since critical care is so expensive, I've started making a powder out of regular science-selective pellets in the blender, and use that instead)
 
Thanks for your very detailed post! I think when the pain relief was first prescribed, it was when she only had the respiratory issues, and it was a 'just in case she's in pain' sort of thing, which is why the relatively low dose, its only now the other symptoms have cleared pain has become more of a consideration.

She weighs about 2.25kg now,
So now she's on 1.3ml loxicom (the 1.5mg for dogs) once a day,
emeprid dose is 1.1ml twice a day, (has been on this for last 10 days)

We'll see if the higher pain meds changes anything, and then see if twice a day is needed.

She has been pooping this past week, and fairly normal shape too, I've not seen her poop in the last day, but it doesn't mean she hasn't (hard to tell when with a companion!)
I'm syringe feeding every two hours, which includes tummy massage time as she only has relatively small amounts each session. I have to water it down much more than it says on the pack, Fine with the CC for now, but will grind up some nuggets if I run out!
 
In true GI stasis, soon gas becomes involved as the bowel's contents start to ferment without being moved along. The gas-related pain becomes rather visible. They will be reluctant to move, lay in weird shapes (to try to ease pressure from their bellies), grind their teeth, may seem lethargic and may breathe rapidly. GI gas pain is extremely painful to bunnies, and one of the rare cases where they can no longer hide being in pain. If none of that is the case in your rabbit currently, and if she has regular and normal-shaped poops, then I think she currently is not in stasis. In true GI stasis, no poops would come out and gas buildup will become a problem real quick. If I read it correctly, you have been force feeding for an extended amount of time, in stasis one would have expected a load of other problems at this point.

So if I'm reading it correctly, your problem is mostly that the rabbit stops eating by itself, correct? Other than that, she has no bloat or gas episodes, no obvious pain-indicators (like what I just described), and behaves normally otherwise?

If that is the case, imo that rules out GI stasis and it sounds like you should look for other causes. Dental is a possibility, if chewing is causing her pain she will eventually stop eating. You might see improvement on properly dosed metacam in this case, though be warned that any underlying dental cause will not go away on its own and needs to be investigated either way.

Other options that come to mind, since you also said she had something else bacterial, is ear infection. If an infection is growing inside her skull, this discomfort might make her stop eating and cause lethargy at times. As the pus inside the inner ear expands, neurological symptoms may appear. Chewing might cause additional discomfort in the skull, which could be another reason for them to stop eating.

E.Cuniculi is a tricky one, hard to diagnose through tests and sometimes silently working already in your bunny. Luckily, the medicine (panacur) is very very well tolerated by rabbits and can safely be given either way. Proper treatment duration is 28 days of panacur at the appropriate dosage. Many (if not most) rabbits carry E.cuniculi within them from their early youth with no problems. When the immune system is weakened by another infection, it can flare up. This has happened in my 12 year old rabbit who had an airway infection which was treated by antibiotics however was quickly followed by severe neurological symptoms from E.Cuniculi having grabbed their chance. My bun made a full recovery on panacur/meranox (fenbendazole). One of the early symptoms of E.cuniculi is "unexplained weight loss". Visible neurological symptoms such as head tilt, ataxia etc, mean it is relatively far progressed.

Bottom line, I think something other than GI stasis is going on. In the meantime, you're doing a good job on the syringe feeding - keep that up, and try to keep her weight stable! :)
 
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I think Boxbun has a really good point. If she's been pooping, and they've looked fairly normal, and the pain relief was for just in case, so she wasn't showing obvious pain signs (though you did say she was sitting hunched, which might indicate pain), it doesn't sound like GI issues are the main cause of her not eating right now. I'd personally want more testing to be done if she were my bun, especially after such a long time and with her having gotten worse again when she was doing better, but it's your choice, of course. In addition to Boxbun's ideas, if she has tooth root issues, for example, that can cause both upper respiratory issues and pain while eating. You'd need a skull x-ray to diagnose that.

It sounds like you're getting a decent amount of food into her, though, if she's taking 15ml every two hours, so that's really good :)
 
I'm more relaxed today as she's eaten some dandelion leaves and fresh grass. Boxbun that's a ton of information and next steps to look out for. Yes the main issue is that she isn't inspired to eat for herself. She's not as active as normal, but more than she was. She did have stasis - There was an issue of no tummy noises on one side for a while, and she had no droppings, and then the tiny dried up poos, but I think now that's mostly resolved, and we are dealing with the after effects.

She hasn't been stretching out and there's no visible bloating. She mostly huddles in loaf position, sometimes more relaxed and sometimes more hunched - Today she has eaten some dandelion and some grass I plucked for her, so I'm relieved the weekend panic is over and think the increased pain relief is helping. She isn't really foraging for herself and only seems to eat when I put something tasty right in front of her - She wouldn't care to hop across the shed for the snacks, when before all this illness she would always dart instantly for food. I keep placing fresh piles of hay around her just in case she's inspired to take a bite! Saying that, she does still move about, she uses her runaround tunnel to get outside etc, so I know she can move and doesn't seem to be struggling with her legs.

At the moment we are waiting a couple of days to see if the tear duct flushing and increased pain relief makes any difference - the vets wondered if she had blocked sinuses, although the tear duct cleared on flushing, there was a bit of discharge. She had slight discharge in her eyes when she started being snuffly, which we think is due to the infection, but if it comes back again that would be a sign there's a dental issue perhaps. If it had been blocked I would have been more certain there was a dental issue. I'm assuming if it was an ear infection, then the course of antibiotics would have helped that too, would make sense if the ear infection caused the respiratory problems. A week of baytril sorted the snuffle sounds, but maybe needs more if something is up with the ears.

The vets have been hesitant to do anything which requires a scan, due to the recent respiratory issue and risk of anaesthetic or sedation, I've not pushed it as there didn't seem to be any obvious symptoms that required it. The vets just seem to think its just going to take time to get back to normal. I'm not sure what happened at the weekend to make it go backwards though.

She's lost about 200/250g in the last few weeks, but has maintained at her current weight the last week. I'm popping to the vet tomorrow to pick up a repeat prescription for the pain relief and will check about panacur then.

Sorry I always write essays!
 
She's eaten a radish today for the first time (I've offered them a few times before) , some dandelion leaves and even some hay!
That's wonderful! :love: She's choosing an interesting time to try something as odd as a radish for the first time, haha. I'm glad to read her weight is stable at the moment, too, and that the extra pain relief seems to be helping her feel better. If she's still sitting hunched at times it sounds like she might still have some discomfort, but it's a good sign that she's eating more. Hopefully her interest in food will keep improving.

Just out of curiosity, does your vet not do conscious x-rays? Even my wriggly buns who hate being held have never needed anaesthesia or sedation for x-rays.
 
They only talked about the risk of sedation so I'm not sure they do. I'll check if things don't improve.

Had a call with the vet today, They weren't keen on the idea of using panacur and advised using fibreplex to help with gut health instead, as it can do more harm than good to the gut flora, which will already have taken a hit from the antibiotics. We will keep an eye for any signs of parasites however.

I've also asked about supplementing the loxicom with calpol to make sure the pain relief is lasting the full 24 hours - they are going to look it up and get back to me with a suggested dose. We also talked about using calpol in the long term just for general arthritis. It feels good to be talking about long term options, rather than just what will get her through the next couple of days!
 
It sounds like you have a good plan on how to go forward, and I think making sure she has pain relief for the long term is a great idea if she has arthritis. Fibreplex has always worked well for my bun with a senstitive tummy. It apparently tastes delicious if you ask mine, so hopefully Athena will like it. I think your vets have a good point about the Panacur, though I realise I'm disagreeing with other people in your thread. It's still a medication with side effects, so it's not something I'd like to give just in case.
 
No I'm glad I checked, I think it would be a safe thing to offer to buns generally if it hadn't been for the antibiotics use, or something else that means your rabbits tummy is more sensitive.

Every day is entirely different at the moment! Thank you so much for holding my hand through it all.
 
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