Advice about impaction treatments

[alexandra94]

(This is my first post on BinkyBunny, so I apologize if I’ve put this in the wrong place/done anything wrong. Please do let me know!)

My darling boy Mr Bugs has been receiving treatment for an impaction for about 3 weeks now. A lot has gone on, but long story short is (from what my vets can tell) he has an impaction of feces in his cecum. He’s eating well, though is VERY up and down with his mood/pain/energy levels, though I think a lot of that has to do with the constant trips and stays at the vets. He IS passing feces, but again it’s very up and down with the amount.

He’s currently on:
Vetergesic twice per day (I’m just now realizing I don’t know the dosage)
Emeprid 1.25ml – 3 times per day (he was only taking that 2x up until 3 days ago)
Zantac 0.9ml – twice per day
Baytril 0.52ml – twice per day
He’s been receiving fluids via IV for the past 8 days, but only during the day (while he can be at the vet) and also sub q fluids. (though I found out for today he’s only had sub q, as his ears have become painful/difficult to find a vein – I’ll be talking to the vet about that tomorrow, as I feel it’s vital.)

The impaction has gotten considerably smaller in the past 3 weeks, but the size of it has been going up and down, but not really showing improvement in the past week. There is one part of it that is a lot harder than the rest, which my vet is assuming is the problem.

Does anyone have any advice for me?
I’ve read that mineral oil enemas can be helpful. Does anyone have any experience with that? I could carry on with this current treatment for as long as he’s still coping with it, but I can tell he’s starting to struggle now. It’s a lot of stress for my baby.

And I’ve been reading good things about Simethicone, would it be at all risky to give it to a rabbit with an impaction? I know it’s not a cure, but it might make the gas less painful, and we could then possibly decrease the vetergesic. (My own thoughts.. I’m no vet!)

 I hope this post isn’t too long, it would be soooo very much appreciated if anyone could help. I’ve had bunnies for years, but I’ve never been through anything like this with them before.

Thank you! (:

[Sarita]

Simethicone won’t help at all with an impaction. I have heard enema’s are very good but have never done this – it’s just getting fluids in another way to help soften the impaction.

Dana Krempels talks about the enema in her article, here it is:

http://www.bio.miami.edu/hare/ileus.html

[LittlePuffyTail]

I wish I had some advice for you but I just wan to wish your bun a (((Speedy Recovery))))

[LBJ10]

Hmm, thought I posted but it doesn’t appear to have gone through.

I agree with Sarita. That might be something to ask your vet about.

[alexandra94]

Thank you for your replies! And thank you LittlePuffyTail, he needs all the good vibes he can get

I’m trying to find a more rabbit savvy vet, as although his current ones are wonderful and have done an excellent job, they’re reluctant to do anything more. My boy hasn’t given up yet, so I certainly won’t.

[kirstyol]

I don’t have any advice as such, I think the vet is probably doing the best they can with medication at the moment, although I am a little puzzled by the antibiotics, do they suspect infection?

Sub cut fluids are just as effective as iv, less painful but they do take a little longer to be absorbed which in some cases is a good thing because fluid overload is a bad thing Did they tell you why they were giving both? That’s a bit odd to be honest. Is your bunny drinking normally? If so I actually don’t see what fluids are doing to help other than hoping that they will soften the blockage, but if that’s not worked after 8 days I cant imagine it will now. You do not want your bun to have fluid overload so I would definitely be asking if the fluids are necessary and why they think that’s the case.

the ranitidine and metoclopramide (that’s the zantac and the Emeprid) should help move things through the digestive system, they stimulate different parts of the digestive system so work well together.

I wonder if changing the vetergesic for something else might help though. vetergesic is an opiate and they can cause constipation which will not help things at all, perhaps meloxicam would be a better choice but I am not a vet I am just basing this on my knowledge of drugs in humans which is remarkably similar to drugs in rabbits.

I have no experience with enemas in rabbits, but I do know that to be effective in humans, the blockage needs to be near the end of the digestive tract, if the blockage is too far up they simply don’t work because it doesn’t actually get there (sorry I tried to make that the least graphic I could). I also cant imagine that a rabbit would tolerate an enema, but again I have no experience.

I hope your bun passes the blockage soon!

[Kokaneeandkahlua]

I can’t help -never experienced this-but sending {{Healing Vibes}}

[LittlePuffyTail]

Please keep us updated on how your bun is doing.

[alexandra94]

Thank you everybody!

Kirstyol, the reason for the antibiotics is because he had quite a bad chest infection when this first started (almost a MONTH ago!). He was admitted via emergency in the middle of the night, and stayed for 6 days and nights at the vet. He wasn’t eating, was in stasis, and he was in a lot of pain. It was a very scary time, and his vet was amazed he came through it.
He came off the Baytril for a few days recently, but myself and the nurses both noticed he had a bit of a runny nose, so to be safe he’s back on it for now.

He’s now spending his days (and nights) at home, and I’m taking him into the vets for his vetergesic and sub cut fluids every morning and evening. Reason being is simply because he was getting miserable at the vet all day.
I was discussing with the nurse today about possibly swapping the vetergesic for metacam, for the reason you said. But I’m worried to change his pain relief, as there are times when he is clearly uncomfortable/in pain, even with the opiates. (If I feel he needs it, I give him metacam. Though 99% of the time he seems fine after a few minutes, and I think I must be paranoid!)
I shall ask the vet about meloxicam though!

I heard that fluids were essential in clearing an impaction, hence the IV /and/ sub cut. He’s now just on about 100-120ml sub cut per day, does anyone think that’s enough (or too much?)?

He’s also now taking Lactulose. I’d love to hear peoples experience with this.
He’s had 0.8ml once a day for the past two days. From today he’ll be taking it twice per day. From what I’ve been told, it should draw the fluid into the bowel/intestine and hopefully soften the impaction. I’m incredibly anxious about this, as it’s a human medication and there are of course risks. The only difference I’ve noticed so far, is that he’s drinking more. (Though only with encouragement, as he usually drinks very little.) I’m keeping a close eye on him, and praying it’ll work.

He’s very bright, eating a LOT, and for the first time since this started, he demanded (not asked haha) to be let out of his bedtime cage at 6am this morning. All reassuring signs to me. Thank you for your replies and healing vibes, makes me feel a little less alone! <3

[kirstyol]

Most of the medicines he is currently getting are human medicines, I was actually very surprised how similar rabbit medicine is to human medicine. Its why you often find me offering advice to people whose buns are on meds because I know a fair bit about human meds (I am a few weeks away from being a nurse) and they are very similar.

Lactulose does work by causing water to be drawn into the intestines, softening stools in the process. In humans its often prescribed to people on opiates to relieve the associated constipation. It does cause gas though, that would be my worry when giving it to a rabbit as its known to cause bloating and gas in humans. I have done a quick search and while it seems most laxatives are not recommended for rabbits, lactulose seems to be ok for short term use as long as you watch out for gas problems. I don’t know how big your bunny is but an adult human normally takes 10ml of lactulose and it can be taken a few times a day up to 30mls three times a day if needed, so comparing it to other meds I know of that are used in both humans and rabbits, 0.8mls seems reasonable to me.

He will drink more while taking it because more water is being drawn into his intestines meaning he will need to take more in so that he keeps enough water in the rest of his system.

I would definitely consider switching to meloxicam, it might help and if you still think he is in pain there is no reason why he couldn’t be given something else on top of it. Meloxicam is an anti-inflammatory and an effective painkiller as long as he is eating.

its hard to decide if the fluids are enough/too much because I obviously cant see your bun. Is he peeing a lot? As long as he is peeing out whats not being used by his body its not a problem and I assume the vet will be keeping an eye on this. again, he will need more water than normal because of the lactulose so if he is not drinking a lot he will need the extra.

I am glad he is brighter, that’s a great sign!

[LittlePuffyTail]

I’m glad your bun is in good spirits. He is certainly lucky to have such a caring bun parent.

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