Wallace's Gastric Ulcer
Hello again, readers,
Today we wanted to discuss Wallace's gastric ulcer which occurred some time back. It was a stressful occurrence which we wouldn't wish on anyone, however, it taught all involved a lot about rabbit healthcare.
GI stasis is a medical emergency that can be fatal. Harmful bacteria can build up in the rabbit's gut which can also lead up to a build-up of gas, and bloat. This can be extremely painful and stressful for the patient, which then further decreases the motivation to eat and drink - like we've already mentioned, it's a domino effect.
We knew Wallace had ileus as he suddenly became anorexic (completely unwilling to eat independently) and his faecal quantity had also declined - the faeces themselves were also abnormal. He was also showing signs of lethargy: a common symptom of GI stasis. We took him to the vet within a matter of hours.
Absolutely everyone has made errors during their career - even us.
Yes, both us and the vet themselves acknowledge they were incorrect on this occasion. They even admitted they'd never come across gastric ulceration with a rabbit-patient before. The vet has taken Wallace's case as an experience that they can now carry with them for the next patient. We are all still on good terms.
Unfortunately, our preferred vet with exotic training was away for a brief period when Wallace struck ill, but we knew he needed urgent medical investigation at the very least. After a general health check, the vet noticed that Wallace had some molar spurs which needed filing down under a GA (general anaesthetic). The vet believed that Wallace may have minor molar malocclusion which, if severe enough, leads to there being some spurs on the teeth due to an inability to effectively wear down the teeth.
In simple terms; Malocclusion means bad alignment/misalignment of the teeth. "Occlusion" refers to the alignment and contact of the teeth between opposing dental arches (when the jaw is closed), and "Mal" means bad, poor, or abnormal.
Thankfully, we had caught the spurs before there was any ulceration or damage to the mouth. The vet was able to perform the minor procedure which should've hopefully made Wallace's mouth a little more comfortable.
In the meantime, Wallace was introduced to sporadic syringe feeds of Oxbow's 'Critical Care' recovery diet in order to keep his gut moving, although it is always far more beneficial for the patient to eat as independently as possible, as soon as possible. The vet also introduced him to Metacam/Meloxicam (NSAID) to help relieve pain and inflammation, he was also prescribed Metoclopramide syrup (GI Prokintetic) to help kick his gut back into gear and keep things moving.
In our experience, you should normally start to see improvements by 48hrs if the spurs were truly the primary cause of ileus (we've had many encounters with Quinnie), but it can take a good few days to get a rabbit completely out of stasis - deterioration shouldn't be observed.
On the 4th day of anorexia, we could see Wallace was deteriorating. Not only that, but he was now at risk of further complications. We decided it was appropriate to readmit Wallace. Despite having a previous diagnosis of molar spurs, I wasn't entirely convinced they were the primary health concern causing his symptoms, my theory was that they were, in fact, a secondary complication due to a larger issue.
Our usual vet had returned from their holiday, but they were based at the Newcastle branch on their first day back. We decided it would've been within his best interest to be admitted in Newcastle instead of our home town - Congleton. This way, he was getting more experienced care.
During his clinical investigation, our vet discovered that Wallace was grinding his teeth (a sign of pain) when his cranial (front/forward) abdomen was palpated. No masses could be felt and small audible gut movements could be heard when auscultated with a stethoscope - a positive sign that he was not in total stasis. Wallace was also producing small black faeces, which was an extremely concerning symptom.
Our vet advised Wallace had some X-Rays (lateral/side view) taken and a basic blood screening. We were happy to oblige.
Radiographs were reassuring; any obstruction could be safely ruled out as food can be seen throughout the gut. The blood screening was also unremarkable; nothing to suggest hepatic lipidosis (commonly known as 'fatty liver'), hydration was also good due to intermittent syringing. A low urea level was present but that was due to anorexia, so was expected.
Our vet consulted the exotic specialists at Cheshire Pets, together they came to a primary diagnosis of a gastric ulcer; after a home-visit, our vet could find no obvious cause.
Later that day, Wallace was transferred to Smallthorne so our vet could monitor him throughout her working day. At the end of the working day, he was discharged with subcutaneous Buprenorphine (opioid) injections, Ranitidine (histamine antagonist/ H2 blocker), Gaviscon (antacid) which shouldn't be used long-term due to potential calcium build-up. The drugs were used alongside his already prescribed Metoclopramide and Metacam; should be used with caution when gastric ulceration is present, however, multiple vets believed it was more important Wallace started eating independently. He continued with his intermittent syringe feeds of Critical Care and luke-warm water.
When he came home, Wallace continued to eat certain foods independently
Not long after Wallace had started eating, he'd suddenly stopped eating again. He was also more reserved than he had been a few hours earlier. He was taken back to the vet once again for examination.
Today we wanted to discuss Wallace's gastric ulcer which occurred some time back. It was a stressful occurrence which we wouldn't wish on anyone, however, it taught all involved a lot about rabbit healthcare.
Please note that we will be discussing Wallace's medical history. The information given within this post should not be used as a substitute for medical advice from your own qualified medical professional if your pet is ill.
It all came to light when Wallace suddenly came down with a case of ileus: largely speaking, ileus refers to a lack of movement somewhere in the intestines. It can also be referred to as gastrointestinal stasis/GI stasis. It seems to be common health problem amongst rabbits. As soon as they're sick, they usually stop eating - it's a domino effect. We'd say in most cases, there is normally a culprit behind ileus.Initial signs of illness:
GI stasis is a medical emergency that can be fatal. Harmful bacteria can build up in the rabbit's gut which can also lead up to a build-up of gas, and bloat. This can be extremely painful and stressful for the patient, which then further decreases the motivation to eat and drink - like we've already mentioned, it's a domino effect.
We knew Wallace had ileus as he suddenly became anorexic (completely unwilling to eat independently) and his faecal quantity had also declined - the faeces themselves were also abnormal. He was also showing signs of lethargy: a common symptom of GI stasis. We took him to the vet within a matter of hours.
The misdiagnosis:
Firstly, we wish to clarify that we are not 'slating' the vet who made the misdiagnosis; they are not an exotic specialist and only know "general" rabbit health - something we knew when booking an appointment. They're a knowledgable vet with a fabulous reputation.Absolutely everyone has made errors during their career - even us.
Yes, both us and the vet themselves acknowledge they were incorrect on this occasion. They even admitted they'd never come across gastric ulceration with a rabbit-patient before. The vet has taken Wallace's case as an experience that they can now carry with them for the next patient. We are all still on good terms.
Unfortunately, our preferred vet with exotic training was away for a brief period when Wallace struck ill, but we knew he needed urgent medical investigation at the very least. After a general health check, the vet noticed that Wallace had some molar spurs which needed filing down under a GA (general anaesthetic). The vet believed that Wallace may have minor molar malocclusion which, if severe enough, leads to there being some spurs on the teeth due to an inability to effectively wear down the teeth.
In simple terms; Malocclusion means bad alignment/misalignment of the teeth. "Occlusion" refers to the alignment and contact of the teeth between opposing dental arches (when the jaw is closed), and "Mal" means bad, poor, or abnormal.
Thankfully, we had caught the spurs before there was any ulceration or damage to the mouth. The vet was able to perform the minor procedure which should've hopefully made Wallace's mouth a little more comfortable.
In the meantime, Wallace was introduced to sporadic syringe feeds of Oxbow's 'Critical Care' recovery diet in order to keep his gut moving, although it is always far more beneficial for the patient to eat as independently as possible, as soon as possible. The vet also introduced him to Metacam/Meloxicam (NSAID) to help relieve pain and inflammation, he was also prescribed Metoclopramide syrup (GI Prokintetic) to help kick his gut back into gear and keep things moving.
In our experience, you should normally start to see improvements by 48hrs if the spurs were truly the primary cause of ileus (we've had many encounters with Quinnie), but it can take a good few days to get a rabbit completely out of stasis - deterioration shouldn't be observed.
Re-admission and final diagnosis:
Unfortunately, we couldn't see any improvements with Wallace despite persistent syringe feeds and additional stimulating medication. He was even taken to the vet a further 3 times to receive intraperitoneal saline to help lubricate his gut, hopefully making it 'easier' to digest food.On the 4th day of anorexia, we could see Wallace was deteriorating. Not only that, but he was now at risk of further complications. We decided it was appropriate to readmit Wallace. Despite having a previous diagnosis of molar spurs, I wasn't entirely convinced they were the primary health concern causing his symptoms, my theory was that they were, in fact, a secondary complication due to a larger issue.
Our usual vet had returned from their holiday, but they were based at the Newcastle branch on their first day back. We decided it would've been within his best interest to be admitted in Newcastle instead of our home town - Congleton. This way, he was getting more experienced care.
Our vet advised Wallace had some X-Rays (lateral/side view) taken and a basic blood screening. We were happy to oblige.
Our vet consulted the exotic specialists at Cheshire Pets, together they came to a primary diagnosis of a gastric ulcer; after a home-visit, our vet could find no obvious cause.
Later that day, Wallace was transferred to Smallthorne so our vet could monitor him throughout her working day. At the end of the working day, he was discharged with subcutaneous Buprenorphine (opioid) injections, Ranitidine (histamine antagonist/ H2 blocker), Gaviscon (antacid) which shouldn't be used long-term due to potential calcium build-up. The drugs were used alongside his already prescribed Metoclopramide and Metacam; should be used with caution when gastric ulceration is present, however, multiple vets believed it was more important Wallace started eating independently. He continued with his intermittent syringe feeds of Critical Care and luke-warm water.
When he came home, Wallace continued to eat certain foods independently
Not long after Wallace had started eating, he'd suddenly stopped eating again. He was also more reserved than he had been a few hours earlier. He was taken back to the vet once again for examination.
Given that he had been eating (hay was palpated in his intestines) and was still producing black faeces, it was likely the gastric ulcer was more painful once he had food in his belly. Our vet decided to introduce Wallace to intramuscular synthadon/methadone (opioid) injections to help relieve some the pain - Buprenorphine was discontinued. They also upped the frequency of Metacam and Ranitidine administration. Luckily, although he was lethargic (side effects from Synthadon), Wallace began eating again.
After a few days of continuous improvements, the Synthadon was discontinued and Buprenorphine was re-introduced. Wallace continued to eat and drink independently, so Metoclopramide, Gaviscon, and Buprenorphine were discontinued too.
Eventually, Wallace's diet became more varied, he started to include his hay, pellets, and morning herbs. As a result, the frequency of Metacam and Ranitidine were decreased then slowly discontinued.
Wallace has had no further health complications, including no reoccurrence of molar spurs despite minor molar malocclusion.
You can keep up with Wallace on our Instagram.
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