A week ago, I had a very busy weekend. On Saturday, Bunny came in for what was supposed to be an upper respiratory infection. However, on physical exam, the rabbit had a very large urine filled bladder that was difficult to express. I was concerned the rabbit could have a bladder stone or sludge and according to the owner, Bunny had a history of bladder sludge that was previously treated. For those not familiar with bladder sludge, this is a medical condition in which calcium salts build up in the urinary bladder. Rabbits are very efficient about absorbing calcium from the diet and the kidneys filter the excess out for excretion. Some rabbits also have a genetic predisposition to this problem as well (this is suspected in Bunny). The excretedcalcium will combine with other minerals and you end up with a clay like substance that sits in the bladder. This sediment, aka sludge, is so thick and irritating that it can lead to bladder inflammation, difficulty to urinate, infection, and cause the pet to not feel well. Radiographs (x-rays) confirmed a diagnosis and I recommended medical management to help with the symptoms. Often, treatment includes fluid support, massaging and expressing the bladder, antibiotics, and pain medications. I also recommended a medication to help improve bladder tone and make it easier for Bunny to urinate. We had planned on following up on Monday as well. The following day, I received a call that Bunny needed to go to the ER in the evening because she stopped urinating. They were able to give more fluids and express her bladder but by Sunday morning, she was struggling again and the owner wanted to see if we can give more fluids in the morning. So I came in on Sunday and we talked about how Bunny was doing and that morning she really wasn’t eating well. After giving fluids, I attempted to express her bladder but at that time I was unable to express any urine except a few drops. Now it became a concern that she was obstructed. We discussed attempting to catheterize and see if I can empty her bladder with a catheter and the owner consented. We were both concerned since Bunny was debillitated and this will require general anesthesia. But I didn’t know what other choice we had. After preparing everything, my assistant and I sedated Bunny and attempted catheterization but to no avail, it was just not successful. When I called Bunny’s owner/mom, I discussed my concerns and difficulties and we talked about the next step. Although risky, the next option is a cystotomy which means opening up the abdomen, opening the bladder and flushing out all of the material. There were anesthetic risks, risks that she still would not be able urinate after surgery, and risks of infection. Unfortunately, our only other option was to consider euthanasia. Bunny’s mom opted to give surgery a try so we proceeded. The surgery was tricky since I had to flush out sand as well as grit the size of small pebbles. I had to liberally flush the abdomen of any of the sediment that had managed to migrate out of the bladder and I had to make sure we tried to get every little piece out. It wasn’t easy and there was no guarantee that I could get every thing. Finally, I reached a point that I felt I had done all that I could so I closed my incisions and we woke up Bunny. She was amazing through surgery and after. Bunny’s mom was able to transfer her to the overnight emergency facility for further intesenive care. After I left, I continued to fret about this bunny for the next 24 hours–most vets cannot leave their job at the door. But the next day I received a call that Bunny was urinating on her own and starting to eat. The plan was that she would be released from the hospital the following day if she continued to do well. By Tuesday, Bunny was able to go home! Now its a week later and Bunny came in for a recheck visit. Her owner has worked hard with her all week to assist her feedings and give injections as well as oral medications. All of the hard work has paid off. Bunny is doing really well, eating, urinating and active. She still has to finish her recovery and will need long term monitoring for recurring sludgy bladder but she is a fighter and I am so glad to have been a part of her recovery. Not all emergencies end up the way you want, hope, wish–so I never take the good ones for granted. This happy ending will stay with me.