Slow recovery from blockage

[GrahamBunneh]

Hi, used to be on here long time ago hope everyone is good!

My rabbit Pumkin suddenly stopped eating 4 weeks ago, blockage with really bad gas build up. I was slow in getting him to the vets tbh as it was a sunday, and i've only dealt with slower onset stasis situations before. He got through the first couple of days intensive care and we started the recovery process. Arthrocam, cisapride, and something else I cant remember, plus initially a syringe feed. The syringe feed initially was hard and he spat most of it out and we didn't get given a lot of it, but he had started to eat so I left it quite early - there is possibility stopped the feed far too soon.

After week 1 on the meds we tried coming off them and had mixed results, and ultimately did an extra xray - didnt show any teeth issues, and what was probably the remains of the blockage. So week 2 was back on meds and syringe feed. Often felt like I was having to encouraging him to eat rather than him foraging it out.

Week 3 we tried coming of the meds and feed again. Day 1 was good, but day 2 not so good and I gave him a syringe feed, day 3 really good (only day I've seen him fully eat enthusiastically), day 4 not again. The theme seemed to be he was eating better the day after getting a syringe feed. So by end of week 3 was doing daily syringe feed again, but no meds - half working but not great.

Week 4 we decided to start arthrocam again, and I've been increasing how much syringe feed he gets. He is eating - he gets excited about veggies, he does eat some hay, doesnt seem to lie in weird positions, but also he still does occasional teeth grinding. Also I havent seen him drink and I think he maybe used to mainly get moisture from veggies. I wonder if he needs more fluids atm and his normal routine doesnt support his current needs. His poops are mostly still small - we had a total of two large golden nuggets, but rest of time they have been on the small scale.

• Initial syringe feed prob didnt go well and should have been more consistent
• syringe feed is def helping - whether thats just due to motility or maybe it him getting extra liquids I'm not sure
• he doesnt appear to have teeth issues
• eating veggies and hay moderately but am missing the enthusiastic wolfing it down I expect - we had one day of that and I'd love to work out why
• He's fussy about what he eats in terms of veggies and hay
• he doesnt appear to drink from his bowls
• plenty of poops, but still small

If its the remains of the blockage keeping things slow, then I think the syringe feeding is prob best thing to keep gut moving and get extra liquid in him? maybe I need to increase the amount?
I'm also wondering does he still have some gas issues? I suppose diet modification is best way to improve that? Plus just seen how to do tummy massage whcih we can do at meds time.

So progress has been slow but there has been progress. But also its been very slow and I'm still looking for that sign of being enthusiastic hay chomping without prompting or needing meds.

Any hints an tips at this stage would be appreciated

 

[SarahP]

When I had bunnies with recurring stasis issues, the thing that helped most (other than the meds from the vet, obviously), was syringing fluids rather than food. Peppermint tea is great (preferably slightly warm), and also boiled cooled down to warm water. It really seems to help get things moving.

 

[Shimmer]

Has he had an xray to determine the site and nature of the blockage? Any potential blockage needs investigating as a matter of urgency. Blood glucose levels can be used as an indicator of how bad the blockage is. Syringe feeding should never be attempted if there is a suspected blockage - always seek veterinary advice first.

At this time of year, it could easily be ingested fur from moulting - in which case, you need to be extra vigilant with additional grooming (eg with a comb) to remove the fur before it is ingested. But it could be something else as well, so it needs checking out. Another vet visit to palpate the blockage to see if it has changed might be in order.

In all cases of stasis that I've dealt with, it has been essential to keep up with the meds (pain relief and gut stimulants) and syringe feeding until the rabbit has been passing normal poo and eating normally for themselves for several days. Stopping too early tends to be quite a set back. Sometimes it can take weeks for a full recovery, and some rabbits do seem to be prone to it.

 

[GrahamBunneh]

He had a couple xrays one at the time, and one in week 2 as a followup, he'd had blood checks done during the initial emergency too. His gas build up at the time was really bad. Week 2 showed what looked like the remains of the blockage but nothing significantly concerning. He has recently finished his spring molt and thats def a probability - he's the kind of lionhead other lionheads look at and go wow you're fluffy. He gets regular grooming but still its a whole lotta fluff.

I am of current opinion that the syringe feed didnt go well enough when he first came home, and stopped to soon - he had been eating by that point but not fully. And he generally doesn't get much liquid - maybe enough for normal times, but prob not for recovery. So what I've done over last few days is increase his syringe feed, both amount and frequency, but also increased the liquid content. My main goal this week is to be consistent with it, as i think thats what has been missing.

I've just been out and got some peppermint tea we can experiment with today - although weirdly he's been less interested in mint even though he really wanted it during the initial week after.

I'm also soaking some hay atm. I had read about doing that for bunnies who dont drink enough, but I'm also thinking it might help digestion generally, as I swear I hear him grind his teeth most when he's just eaten hay. Vague theory that hay is driest thing he eats and therefore least comfortable thing - who knows though its just a guess.

I am feeling positive that his behaviour is generally good - he has zoomed last night, he jumped on the sofa to pester me this morning. There's lots of poops and pee in his tray even if they are still small. He just needs to eat way more.

 

[Shimmer]

Has he had his teeth checked properly? There may be dental issues if he's not been eating properly fr a couple of weeks and is now struggling with hay.

You could try him with fresh grass instead. It's a bit easier to chew than hay, is plentiful now, and has added moisture.

 

[GrahamBunneh]

He's had his teeth checked a few times now - most recent was thursday. Not perfect after his issues, but nothing that looks uncomfortable or problematic. I've no grass but i did soak some timothy hay see if being fresher and greener helps - he's not touched it yet. I'll see if I can get some actual grass from somewhere though.

Peppermint tea seemed to go down well when I tried it in syringe, but he's not touched the bowl of it yet.

Been trying tummy massages last few feeding rounds see if he likes it - the tummy wiggles seem acceptable, less so picking his back legs up. Not even sure he's got gas that bad atm, just another thought that discomfort from that wouldn't help.

 

[GrahamBunneh]

Been struggling to get on here and update. Yesterday afternoon he seemed to go downhill and I was preparing for an emergency vets trip. He'd taken his meds and feed in the morning, but then I hadnt seen him eat anything since and he seemed really uncomfortable.

Before I did anything else though I got him up for a syringe feed, and I had also finally picked up some simethicone at lunch. The change was fast and very obvious. In last 24 hours his eating has massively improved and his poop size has increased. Not perfect by a ways but getting there.

I'd held off on getting simethicone as most recent things I've seen suggest it doesn't do anything, and vet didn't think it would help. I'd basically tracked some down due to getting frustrated with trying everything else. However it works its done something .

Plan now is to basically continue with this routine and be consistent with his meds/feed routine.

 

[GrahamBunneh]

Very tired today - been ill myself. This weekend we are back to Pum refusing half his syringe feed, while also not really touching his veggies. Had some larger poops, but also a squidgy bunch (not like normal caecotrophs though), and all still very dark.

At this point I'm convinced the issue is dragging on due to lack of hydration. After he eats hay he looks uncomfortable - grinding, fidgeting, panting, more likely to flop over. I've tried giving him fresh grass which he sorta nibbles but no more than any other hay.

If he doesnt drink, isnt eating his veggies properly, and spits out more than 5ml of feed, then he wont be getting enough for recovery. Feeling at a bit of a loss how to resolve that. I tried giving him a bottle again but I'm not sure he even recognises what it is. I could try a fountain but i suspect the cat will claim that in same way she claims every other water source in the house.

 

[Shimmer]

Sounds like he needs reassessing by your vet, including dental issues which may be developing from not eating properly.
Is he still on any meds?
Are you monitoring his weight weekly?

 

[GrahamBunneh]

Hes still in the arthrocam for now. We've a catchup with the vets later and will be doing a revisit soon as im healthy enough to drive.

Hes scamping around this morning and just chomped some hay but grinding a little after. Just missing the last bit of the puzzle to stabilise him again.

I've started weighing him as of last week - slight increase he lost some during the original stasis but has been putting some back on.

 

[SarahP]

Once everything else is ruled out, eg. dental issues, or other issues causing pain, you could consider E Cuniculi. It can cause stasis issues (as it did in my bunnies many years ago, taking far too long for a diagnosis). Your vet may or may not consider this based on gut issues alone.

 

[GrahamBunneh]

Thanks - will add E Cuniculi to the list and have a read up.

Just watched him sniffing around the water bowl as I moved it. Thought occurs that maybe he doesnt like it cos he has stupidly floofy cheeks and maybe he'd struggle to drink without getting soaked just one of those odd theories you come up with while trying to understand the fluffy brained idiots behaviours

 

[GrahamBunneh]

Bit of an update. This week i've basically been trying to just be consistent. He gets his arthrocam, a dose of simethicone, and 20ml feed twice a day. He eats his veggies reasonably well, but still not enough hay. He still does not appear to drink. His poops are still mostly medium small, but with some bigger ones appearing, but nowhere near consistent yet. I have seen a reduction in the grinding especially after the use of simethicone, but its still there after eating a chunk of hay. I suppose that feeds into the idea that hes finding hay too dry.

I've had some successes getting him to eat fresh grass, and a herby/flower/hay mix. Been trying all the tricks for hydration such as wet hay, spraying his veg, tea in his water, even given him a waterbottle again. I've picked up a fountain to try today.

Last night he chewed the sofa cushions. This isnt normal and I have no idea where that fits into the big picture - apart from trying to check he's not about to get another blockage.

Due a catchup with the vet later, and we'll prob do a teeth check next week. At the moment I'm not sure if I keep being consistant and see if he slowly improves more, or whether I should increase the dose/frequency of his feed maybe. Last time I tried upping the feed it just meant he ate less and spat out more. Or even if a reduction in any aspect would be sensible - like if hes munching his veg but not hay, should I reduce his veg to encourage more hay He doesnt get a huge portion of veg, leafy greens twice a day - I weighed it in at about 30g a portion.

At this point we're both a bit tired out., but we're just missing some bit of the puzzle, that just gets him chomping away.

 

[Shimmer]

Poo output is governed entirely by fibre input. You won’t get bigger poo without more input.

The sofa chewing suggests he’s looking for more fibre. I would increase the syringe feeds if he’s not increasing the hay / grass uptake, and get his teeth looked at properly.

If he’s eating veg, try some more fibrous forage - willow or apple tree leaves & branches, bramble leaves, etc, rather than the softer greens. Grass is good as well.

I wouldn’t worry too much about how much water he’s drinking, as long as his wee is normal volume & colour. He will be getting water from fresh veg and syringe feeds.

How is his weight doing?

 

[SarahP]

Chewing might also indicate some sort of pain.

Another thing to consider would be whether the veg is contributing to the problem. When I had my bunnies with their constant in and out of stasis issues, it reached the point where they couldn't tolerate any vegetables at all, and eventually even pellets. They ended up on a hay and dried forage diet only. I would definitely try reducing the veg down. And, as Shimmer said, try something more fibrous.

 

[Omi]

For now, I think I would just maintain consistency until you have had his teeth checked by the vet. Any changes to diet will take a while to materialise into something that is obvious and if you change the diet plan after just a little while, you could be in danger of not knowing what part of the diet is having an effect.

Yes, important to know how, if at all, this is affecting his weight. If his weight is largely being maintained then you have the time to experiment with different things. But only one change at any one time.

Ideally, he would be eating more hay, but if you could get him to increase his fresh grass, then this is just as beneficial and also would provide hydration. Also ideally you could replace his greens with fresh forage or tree leaves, which would provide the same amount of hydration, but also probably increased fibre. If a bunny has dried forage then it's necessary for the bunny to drink enough water. But as I said, I would leave as is for now, get his teeth checked, get him weighed regularly and then start to think about preferred changes.

 

[GrahamBunneh]

So over the weekend I upped his syringe feeding regime again. No immediate obvious results, but will keep at it. Having better results getting him to swallow the stuff after making a fresh batch each time, and using herby teas as mixer. He doesnt want tea on its own apparently but mixed into the syringe feed seems to make both more palatable.

He's eating a bit of fresh grass alongside his normal hay, but neither in great quantity. I added some forage leaves mix which again he shows some interest in but not in any great volume. Just found a willow tree in the local park so grabbed some leaves to try later. He's generally just fussy about what he wants to eat, and never in great enough quantity.

Weight is stable compared to last weigh in - like still lower than his normal but up on a few weeks back and not losing any more.

Grinding and twitching after food continues - most obvious after drier hay has been eaten. Cant work out if its 'after chewing' or while digesting as that would indicate if teeth or tummy causing the discomfort. Another tooth check is on the cards for this week though.

Waiting on call back from vets so we can get his check up in this week.

 

[GrahamBunneh]

Had an odd day yesterday - ate reasonably in the morning, but then by midday he was doing a fair bit of grinding which then continued for longer than normal. Ended up giving him simethicone doses and seemed to straighten him out again to point of him zooming around in the evening. Only thing I'd done differently yesterday was use peppermint tea - its been a while since last gave him any and tbh cant remember why I'd stopped. But also he hasnt been interested in real mint leaves in a while and am now assuming that it no longer agrees with him.

His evening and morning syringe feeds have just been warm water based and he took it down fine and behaviour has been scampy. Tbh its only recently I think his syringe feed has actually been going well - maybe finally cracked the code on the fresh consistency that means he downs most of it and it does something meaningful.

We had a few larger mishappen nuggets yesterday but not taking it as meaning anything till I see consistency.

I still await the vets to call back so chasing them is on cards this morning.

 

[Cuthbert&Dillon]

Hope the call back gives more insight.