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Archive for the ‘emergencies’ Category

The vet found irritation on Frank’s tongue on Tuesday, so he went in for surgery on Wednesday, but they didn’t find a molar spur. They found a huge tumour in his throat. It was so big, growing up and over his back teeth (Jesus!). When they found it, they called me and asked if I wanted him put down, because I could not afford the complicated careful removal procedure, and I said okay, but then they looked more closely and said they felt a slash and burn might be successful, so that’s what they did. (I’m sorry, I do not know the technical names of the different procedures at this point.) They’ve sent the thing off to be tested, so we’ve yet to learn whether it’s malignant or benign.

Frank is home now, but he still can’t swallow solid food. Is that because there’s more tumour in there, or because of swelling from the surgery? We won’t know for a few days.

I have worried at times the surgery was a mistake: he’s so old, am I just prolonging his misery? But, no, I’m quite sure the only thing I would be saving if I’d put him to sleep when they found the tumour is money. Frank tried so hard to keep living in spite of this thing. It must have been growing for a long time, and by the end (the vet says) it must have been painful to even close his mouth! But did he ever give up? No, he only stopped eating when he physically no longer could, and even then he stayed happy and active. Both times he returned from the vet he was in such high spirits, running into the kitchen and asking for food, sure (I believe) that he’d been cured. Both times he became (I believe) depressed upon realizing that he hadn’t been, but he bounces back: his mood in the evenings especially is lovely, he tries to nibble greens and hay, and occasionally he eats his own Critical Care and drinks his own water.

The vets said “we gave him a fighting chance” and I think that is right. He has been fighting, and now we’ve given him a chance. If he doesn’t recover, well, at least we tried as much as Frank has been trying. And if he does recover, even if only for another few months before the next disaster strikes, I think it was worth it.

So in the mean time it’s back to force-feeding and force-hydration, but at least he eats his meds on his own (I put them in a ramekin — I’m sure they’re super sugary). Belly massage, belly massage, belly massage! He continues to poo and pee, but his poops still don’t look so hot (understandable), but I think he may have started eating his cecals again! And he’s been struggling with gas (again, understandable considering all the syringe feeding). Yesterday was unbelievable. He was so swollen I thought maybe it was Bloat (and, thus, the end) but I kept rubbing in case it wasn’t. I rubbed and rubbed, and there was much gurgling, and then there was SUCH gurgling, his whole body rumbled, Frank opened his eyes wide and stretched his body out… seriously, I’ve never seen anything like it, even in humans. I never actually heard him pass it but he must have because the bloating went down and the rumbling stopped.

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I guess, at this point, dental trouble could either be the cause or result of Frank’s not eating hay, but I’m very suspicious now about him feeling discomfort or pain in his mouth. I’ve caught him moving his mouth about in odd ways this whole time, and eating in what I thought of as a careful way. Now he’s dropping his food and eating less and less of it. He has great trouble swallowing his cecotropes. He noses around in his food and shows interest but he’ll only take tiny bites, and he’ll take forever to eat them, and as he does little pieces will drop out of his mouth. We’re largely relying on Critical Care at this point, and we’re mixing Pedialyte into his water. His poops are still regular but they’re becoming smaller and conical-shaped.

I’m going to try and get him a vet appointment tomorrow afternoon on grounds of emergency.

If we don’t find any obvious problems in his mouth (irritation on tongue or cheeks, big molar spikes), I wonder if Frank is just getting old, finicky, senile? I wonder if we’d see any improvement with a course of meloxicam (an anti-inflammatory and analgesic)? If so, would this be a for-the-rest-of-his-life situation? It’s hard not going over all the possibilities in my head but, on the other hand, somewhat pointless until I hear what the vet has to say…

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Well, poor Frankie’s in cecal dysbiosis. Maybe. Or he’s tottering on the edge. Or he’s okay?

I apologise for the amateur diagnosis, I’m just trying to understand what’s going on. My cause for concern? Frank’s not eating any (or hardly any) hay. This has been going on at least three days now. And I’m concerned because a diet low in fibre (whatever its reason) will lead to a sick rabbit, yes? Other signs of ill health I’ve observed are:

  • Reduced appetite (I already mentioned he’s ignoring his hay, but he’s also been sluggish with his greens, pellets, and water)
  • Occurrence of unformed cecals (i.e. mushy poops, some large like fecals but they’re not fecals, they smell and feel like cecals — this does make sense, considering the lack of hay consumption; I found a pile of five or so found yesterday; today, only one so far)

We’re not in emergency mode. He’s still peeing and pooping fine (aside from those mushy cecals). His mood, mobility, and energy levels are normal. But I am worried.

My first plan is to stave off ileus, for which my ideas consist of:

  • Forcing water (which I’ve already started doing)
  • Belly massage (started yesterday evening)
  • Papaya enzyme tablets (he’s been on “moult-levels,” i.e. 60mg/day, since his vet appointment last month when the vet felt a little something, maybe fur, in his belly)
  • Simethicone if I suspect gas (I did give him one dose yesterday)
  • Forcing Critical Care, Pedialyte (if he stops eating, drinking)
  • Maybe the vet will give me some pain meds tomorrow (like Torbugesic) in case ileus sets in over the weekend? (I already have some leftover motility drugs, i.e. Metoclopramide)
  • And, of course, encourage encourage encourage!! (I even went out and bought more grass hay today, so now we have four varieties!)

My second plan is to figure out WHY he’s gone off the hay.

  • My first idea is: dental trouble
  • I don’t have a second idea, but I know it could be any number of things

Obviously I need a vet to help me with my plans, but the long weekend is coming up and both my vets are booked solid tomorrow. If it turns into emergency, I’ll go by the closer of the two and they’ll try to squeeze him in. And there’s always (God forbid) the 24/7. Tomorrow I’ll call the vet and ask for a brief consultation, at least.

These two links have informed me:

If you have insight into what’s going on here, please share it with me!

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The new year so far has been terrible. I fell ill on the 28th, and as I started to feel better on the 31st it was only to realize something was wrong with Frank. We don’t yet know why, but he sunk into ileus on the 1st. I suspect this isn’t about a straightforward blockage. We’re still nursing him through the ileus, and we won’t discover the real problem for awhile. Here’s the timeline:

31-DEC-09

  • Mid-morning: A full litter box is scooped and replenished; Frank eats his breakfast and joins us in the bedroom for play-time; a perfectly normal bun.
  • Midday: Frank settles down to sleep as usual.
  • Afternoon: Frank rises briefly to drink some water.
  • Evening: Frank doesn’t rise for dinner or play and hasn’t pooped all day; this is unusual but we’ve seen him like this before only to rise normally overnight, so we aren’t very concerned.

1-JAN-10

  • Morning: Frank ate his dinner greens overnight but left his pellets and papaya tablet untouched; only a few poops in the litter-box; only a little water was consumed and urine output is on the low end; his mood is still reclusive, although he’s more responsive and relaxed than he was the last time (and only other time) we saw him in distress, so I feel hopeful.
  • Day: No change; I begin treating Frank for gas: Simethicone (three doses of 20mg over 3-4 hours) and stomach massage.
  • Early Afternoon: Frank lays down in his play-box for awhile, something he’s never done before, and panic is starting to set in; he hasn’t pooped, and now we’re finding cecotropes; I begin treating him for dehydration with watered-down Pedialyte and posting on discussion boards.
  • Afternoon: Frank stops taking the Pedialyte so we bring him to the emergency vet hospital where they give him a physical exam (he has a normal temperature and a yucky-feeling belly), sub-q fluids, a small shot of pain meds (Torbugesic 0.3mg/kg), and a motility agent (Metoclopramide 0.5mg/kg); total cost $202.13.
  • Night: Frank’s mood/behaviour doesn’t improve and he isn’t pooping or eating, although he’s peeing well and drinking some; we keep him warm with a heat-pack wrapped in a towel, and we sleep in his room on the sofa-bed.

2-JAN-10

  • Morning: We call the vet when they open and bring him in immediately; they give him a physical exam (still a normal temperature) and outline a treatment plan consisting of meds and fluids, 3 days stay, and diagnostics (blood work, x-ray), costing a total of $2,000; we decline, and they outline plan B: meds to go home with us (Torbugesic, Metoclopramide, and Cisapride; and Critical Care), blood-work, and fluids administered that day and the next, to a total cost of $8-900; we agree and pay $609.09 for the day.
  • Day to Evening: Frank’s mood/behaviour slowly improves; some water consumption and lots of peeing; he’s pretty obedient with taking his meds; no poops yet, he eats some cecotropes and leaves others behind.

3-JAN-10

  • Morning: Frank poops overnight, small little things; we return to the vets for more sub-q fluids; poops are consistently coming, although still very small and misshapen; blood test results show low red blood cells and poor liver functions, so after a quick re-test we agree to a shot of iron and an appointment for the 11th to re-test for liver functions; a more in-depth exam of the mouth (involving a scope in the back-room) reveals some tooth spurs but no ulcers in the mouth (yet); possible causes of this bout of GI Stasis are described as liver problems (although this could also be as a result of the GI Stasis – hence the re-test scheduled for next week), dental discomfort (if Frank slips back after we stop the pain meds, that would be a sign), or physical blockage; bill comes to $180.94.

Since then I’ve been nursing Frank at home (luckily I have the week off work anyway). It’s been very exhausting and stressful, but Frank is slowly recovering. For awhile he was eating his Critical Care from a spoon, but yesterday, with his improving mood, he started resisting his meds and we’re back to syringe-feeding; he also started misbehaving last night, biting at baseboards and wire-guards. His activity levels are getting better, but he still isn’t really cuddling with us; although, he has started spending more time on his usual outlooks/places around the room. He’s been wary of us since getting sick, as we’ve been “bothering” him frequently with meds and belly massage.

Water, greens, and hay consumption, and urine output, have returned to normal or near-normal levels. He’s still not eating many pellets, just a bite or two here and there. His feces is looking more normal every day (in size, amount, shape, and consistency – they were a little mushy for awhile there). On the 4th and 5th we spoke with the vets on the phone, but today there hasn’t been a need. We’ve been slowly reducing his Critical Care. We’re still spending nights in his room.

It’s down to waiting, now, to see what happens when he goes off his meds and has another blood test. If this is about a dental problem, we’ll give him the surgery to grind down the spurs (although the last time he was put to sleep for surgery he had a bad reaction and gave the vets a good scare). If it’s about a liver problem, there isn’t much we can do for him. The vet started talking about ultrasounds and this and that, which we can’t afford, so she switched to talking about milk thistle (I think) and other things we can do to “support” liver function. That is what it will come down to. He is an old bun and anyway you can’t squeeze money from a rock (we’re the rock), no matter how much you want to.

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Rabbits don’t vocalize much, so their body language is particularly significant. “The Language of Lagomorphs” has proven a valuable resource, as have other webpages, such as “Fuzzy Bunny,” but due to individual variation, it doesn’t perfectly represent Frank. I’ll write more on this subject later; for now I’ll just write about tooth grinding.

Frank grinds his teeth gently when he is satisfied and blissful – generally, when he’s being petted and cuddled, but also sometimes when he’s laying down in the evening, facing us as we watch TV. (Apparently, rabbits often engage in this kind of “gazing” behaviour, both with each other and with their human companions, as a way to establish and develop intimacy.) People often compare tooth grinding in rabbits to purring in cats.

Frank grinds his teeth at two speeds. At the slower speed, each grind of his teeth is distinct, and he grinds them in groups of 3 or 4: “grind-grind-grind,” and then a few moments later, “grind-grind-grind-grind,” etc. At the faster speed, I can’t count how many grinds he makes, but it lasts one to three seconds or so.

(Apparently, loud and violent tooth grinding is a response to pain and is one of the few signs to look for in a medical emergency. I may have noticed this the evening Frank suffered from GI Stasis, but much more telling was his general sluggishness and unresponsiveness.)

Edit 27 April 2010: At this point, I have heard Frank’s pain-tooth-grinding. It is indeed louder, also “crunchier,” but most telling of all: it is not rhythmically regular, as his purring-tooth-grinding is. More like “crunch-crunch,” and 20 seconds later, “crunch”; 1 minute later, “crunch… crunch-crunch.” You see what I’m getting at?

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gastrointestinal stasis

Last Thursday afternoon, around 4PM, I noticed that Frank seemed awfully sleepy, but I didn’t think much of it because he often is at that time of day. By 6PM his condition hadn’t changed, but again I didn’t think much of it, because it sometimes takes him awhile to wake up. At 8PM his dinner was still untouched, and at this point I became concerned. When I tried to engage him, I found him unresponsive: he wouldn’t eat or drink, he was lethargic, his stomach felt taut and hard, and although he urinated at about 8:30PM, he hadn’t defecated in awhile. Because the vet’s office was closed, I decided to start treating him for gas—a common cause and/or consequence of G.I. Stasis in rabbits. I moved him onto a big blanket in our bedroom so that I could keep an eye on him overnight. I administered three doses of Simethicone before going to bed (see details below), and I spent a lot of time that evening and overnight massaging his stomach and cuddling him. At 4AM he jumped up and ran into the centre of the room, so I rose to give him some attention. At this point I could hear loud gurglings coming from his belly, and when I massaged his stomach I could feel gas bubbles. I administered another dose of Simethicone. For the first time in at least 12 hours, he engaged in some play behaviour, ate a little food, and ground his teeth gently when I petted him. After about half an hour I went back to bed. By 9AM his stomach felt closer to normal, and he had passed two very small fecal pellets. By 10AM he had eaten almost two servings of veggies and a few mouthfuls of pellets and hay, and he had urinated and passed more (albeit still very small) fecal pellets. When I massaged his stomach I could still feel gas bubbles. I made an appointment with the vet for that afternoon, and went to work.

When I brought him in, the vet said his stomach felt goopy and pliable (as oppose to elastic). He thought there was likely a hairball in there which had slowed his digestion and caused the goopyness. He prescribed a digestive enzyme (see details below). He also administered liquids subcutaneously, and advised us to mix 1 part juice with 5 parts water to encourage Frank to drink. (Frank in particular needs to drink a lot of water, because he has problems with urine crystals.) The vet also advised us to double his papaya enzymes whenever he was in a moult, and to remove his old fur by petting him with rubber dish-washing gloves.

Over the evening, Frank steadily improved, so that by the next morning he appeared completely recovered. Disaster averted!

Treatment Details: (Disclaimer: Always seek the advice of a vet if your rabbit is showing signs of pain or illness!)
» Simethicone oral liquid suspension for paediatric use: Available over-the-counter at the drug store; I administered four 0.3cc doses of a 20mg/0.3ml suspension, once every hour for the first three hours (9, 10, and 11PM) and again at 4AM

» Digestive enzyme: Can-Addase powder available at the veterinarian office mixed with plain yoghurt; I administered 2cc doses with food twice a day for 5 days

» Papaya enzyme tablets: Available at the veterinarian office and at health food stores; I administer one 30mg tablet with food once a day (twice a day when Frank is moulting)

» Juice-water: 1 part juice (a clear juice, such as apple) to 5 parts water; I give him at least one bowl of juice-water a day to encourage hydration

» Stomach massage: In general terms, a rabbit’s stomach is located in the left-quadrant of its belly, well below the ribs; I administered the massage by pushing gently but deeply and applying circular motions

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