Archive for July 22nd, 2011

Happily ever after!

Friday, July 22nd, 2011

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.