Clostridium and stasis

[Binkles]

So after three weeks (and three trips to the vet) of trying to nurse Peter out of GI slowdown/ stasis, we finally have a diagnosis: Clostridium. The vet gave me a regimen of gut motility drugs and antibiotics, as well as sub-q fluids to administer at home. The vet took multiple x-rays and find that Peter is very, very, very full of food, but virtually no gas, no tooth problems, and no obvious blockages.

However I just went to massage his tummy and found an enormous hard sausage shaped mass in the right hand side of his stomach just below his rib cage. Sounds like his cecum? In fact it’s so hard, I thought it was part of his rib cage at first! But it isn’t, because it moves. I even tried to very gently pinch it between my fingers just a little to see if it gave at all. It didn’t. It’s as hard as a rock. He’s barely eating. It’s now 12pm, and he’s barely done 9 tiny poops since yesterday at 5pm.

I called the vet and they told me there isn’t much more we can do other than what we’re already doing. I’m terrified…anyone have any experience with something like this?

For a spot check, do these dosages sound right for a 3kg even bunny?

Metaclopramide: .2cc every 12 hours
Cisapride: .2cc every 12 hours
Metronidazole: .8cc every 12 hours
Loxicom: 1cc every 24 hours 

Sub q fluids: up to 150ml every 24 hours

[HopsiclesMommy]

I’m so sorry to hear about your bun. I hope he feels better soon. My bunny has been having GI issues, on and off diarrhea/statis as well, but he doesn’t have a Clostridium diagnosis.

I have never heard of Metaclopramide and Cisapride used together before, they are similar drugs. They might have a different mechanism of working when it comes to improving gut motility though. With that being said, my bun (just under 5 lbs) is on .5cc of Metaclopramide every 8-12 hrs. So with the two drugs combined, your dosage seems just about right or maybe slightly under. Then again I am not a vet, and do not know how the drugs interact with each other.

To help your bun, you seem to be doing all the right things. Gentle tummy massages help, but hydration is the most important. The sub-q injections should cover that. If your bun’s ears are feeling cold, you can put a warm towel/water bag next to him to keep him warm.

[Binkles]

Thanks HopsicklesMommy! Good idea about the warm towel.

From what I understand, Metaclopramide and Cisapride work on different parts of the GI tract. Metachlopramide works onthe upper part and Cisapride works on the lower part. Used in tandem they can cooperate with each other.

[Bam]

It sounds rather like impaction of the cecum, the hard thing you’re feeling. http://rabbit.org/disorders-of-the-cecum/

For clostridium I’ve read that Questran is often given, it absorbs the toxins produced by the bacteria so they can’t be absorbed through the intestinal wall but are transported out in poop-form.

Loxicam is an NSAID so you need to make sure he’s warm enough since it lowers body temp as well as reduces pain and inflammation. A sick bun is often hypothermic to begin with, so I too recommend a hot water bottle (that he can move away from if it gets too warm).

(((((Peter)))))

[Binkles]

Well since the first vet just shrugged off the hard mass, I took Peter to another vet today. She did a super detailed 10 minute long palpation of his abdomen. The rock hard mass is thankfully not his cecum, it’s his stomach.

Basically his stomach is completely full of food (just like the xray indicated) and the food is completely dehydrated, so it’s not going anywhere. She felt virtually nothing below his stomach. (He is still pooping, just very small.)

I assume this started because he stopped drinking completely a week and a half ago. I’ve been supplementing this by giving him super watered down pellets, which I guess hasn’t helped much.

Since his stomach can’t move the dehydrated food, the vet recommended that I stop tree metachlopramide until the mass is dissolved. Does this sound right?

The vet said that the sub-q fluids won’t do much to register the stomach contents; he has to have oral hydration. I’m supposed to syringe feed him water or a water/ critical care mixture…but whenever I do, he just lets it fall out of his mouth. I feel like I’m barely getting any in there. What am I supposed to do?

[Bam]

I find this, scroll to the 6th and 7th paragraphs: http://www.rabbit.org/journal/3-7/gi.html

It does say that a gut motility drug should be given even with a stomach impaction. I don’t know if ranitidin could be sth to try? It’s another gut motility drug that can be used in bunnies. It doesn’t have the same mechanism of action as cisapride or metoclopramide, it targets another pathway. You could ask your vet about ranitidine/zantac. Here’s some detailed info about those three and some other motility drugs used in vet medicine: http://www.merckvetmanual.com/mvm/pharmacology/systemic_pharmacotherapeutics_of_the_digestive_system/gastrointestinal_prokinetic_drugs_monogastric.html#v3330378

Other than that the article says hydration. Since his stomach is so full, feeding him more CC sounds a bit risky, but I’m definitely not a vet so I don’t know. But it seems both oral and sub q or even IV fluids can be used to try and rehydrate the stomach contents.

[Binkles]

Ugh, this is very frustrating. I’ve been forcing a bunch of water on him once every three hours all day (how much actually gets in him, I can’t be sure), and he still has this massive rock hard lump.

What on earth am I supposed to do? I’m really beginning to get exasperated here. He hasn’t eaten in over 15 hours, but he has to eat to get out of stasis, but he can’t because his stomach is so full, and I can’t give much critical care because of that. See why this isn’t working!?

This is a self defeating situation.

I’ve been to the vet four times.

I’ve drained my savings.

I’m so distraught I haven’t gotten sleep in weeks.

I want to punch a hole in the wall.

What. In God’s name. Can I do?

[BB & Tiny]

I don’t have any answers for you, but I am thinking about both you and your bunny, this must be extremely frustrating and frightening

[Bam]

I don’t have any answers either. Call the vet and ask about ranitidine. It’s an OTC medicine for human, sold under names as Zantac or Rani-Q etc, so it should be easily available and it’s not very expensive. You divide a human size pill (150 mg) into quarts then divide again, crush the tiny 1/8 of pill and dissolve in water and feed by syringe. It has helped my buns many times, but they’ve never had full blown impaction, so you should really ask your vet first.

I can see how frustrated and sad you must be, but you are doing everything in your power to help him. If possible, stay calm.
Sending so many good vibes.

[HopsiclesMommy]

My vet recommended papaya tablets for my sick little bun to help with gut motility and digestion. Since Oxbow discontinued their Papaya tablets, the recommendation was Nature’s bounty (for humans). Any other supplement with papain (the enzyme) would do, just stay away from very sugary ones. She mentioned that contrary to the common notion that papaya enzyme helps dissolve hairballs, which she said it doesn’t, the enzyme actually helps with gut motility in general and is a good digestive aid. Maybe that would help. 

Other than that, you could try to mix in some juice (no sugar added cranberry/apple/whatever your bun might like) with your bun’s water. I have been tricking mine with juice recently since he is not good with drinking either, but he loves sweet stuff. I make him sniff the cup with juice in it and lead him to the water bowl and pour a tiny bit into his water when he is there. It usually does the trick. Force feeding water can get tricky, you don’t want the water to go to his lungs.

[Binkles]

Thanks for the tips guys!

Things are about the same. I called the vet this morning and verified that she does want me to feed him Critical Care even though his stomach is full. He has to have something going through him. I’m syringing him roughly 20cc of water every four or five hours to try and hydrate that mass. I’m basically doing everything I possibly can.

She said it may take a while -weeks- to break up the mass since its been in there so long already.

[Binkles]

Peter is actually very receptive to the Critical Care so far. The vet wants me to feed him as much as he’ll eat…but this doesn’t seem right to me especially given that hard mass. What do you guys think?

[Bam]

The article I linked to says to feed CC and if it can take months for the food in his stomach to dissolve he really can’t go without other food for such an amount of time. He must get some nutrients and energy that’s available to his system. The food-lump isn’t available.
I’d no idea that it could take months. I’ll have to read more about it. If you google, try and find info from Medirabbit and the HRS and Dana Krempels, those are trusted sources of high quality.

[Binkles]

Yeah, seems like it’s going to be a long, bumpy road.

I know it’s important to get Critical Care into him, it’s just the ‘as much as he’ll eat’ parameter the vet put on it. Is it really wise to give him unlimited Critical Care?

[Binkles]

Omg, dare I hope? I can’t feel the mass anymore…could that whole huge thing really have broken up in a matter of hours? I mean the thing was like 3″x3″x1″. Is it possible that is just hiding?

[Author]

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