Back to the Vet today...

[kherrmann3]

Yup, after the fiasco on Saturday night, I decided to take Toby in to his regular vet even though he is doing OK now. It is better to be safe, than sorry. I just want a second opinion because the first vet we went to doesn't specialize in rabbits, but the main vet does (that trains his little minion vets). He wasn't in, blah.

Now, I am taking Toby to see Dr. Bloss at the Brook Falls vet (highly recommend them for bunnies! They are awesome)! Dr. Bloss has never seen Toby, but Dr. Follett (the other "exotic pet" vet) has seen him before.

I can have them check out his molars, too, because they were starting to get spurs back in August 2008. The emergency vet said they didn't look too overgrown, but the "nurse" or "vet tech." (whatever you call them) said that the vet hasn't seen too many bunny teeth, so it might be a good idea to get them looked at by a rabbit savvy vet.

Yeah, our ER vet asked me right away if Toby was throwing up. I almost picked up Toby and walked out of the room after that! She was good about everything else, though.

I will update you guys as to what the "good vet" says!

:clover::bunnybutt:

 

[Maureen Las]

let me know andI am glad that you are going to anothervet

Julie pmd me this also butI didn't want to bring it up becauseI knew you were stuck with the ER.

Rabbits don't vomit.
I will share some other info i just learned also when you get back.

 

[Bo B Bunny]

That's why she nearly left..... Rabbits don't vomit!!!! ugh!


I'm glad you're taking Toby in to see the good vet!

 

[naturestee]

LOL, have to love emergency vets. I hope all goes well with his visit to a real rabbit vet today! I've heard nothing but good about that place from Julie.

 

[tonyshuman]

Not a bad idea at all. I've always been a better safe than sorry person. Peace of mind is definitely worth $40 or so.

 

[kherrmann3]

Well, happy news! I don't have to do the sub-q fluids anymore! The vet said that he was doing great! She gave me Metacam to give him once every morning until he's doing everything normal.

As I was paying for the exam, I saw someone having difficulty with the door (from having too much in their arms) and I opened the door and it was Julie! I laughed! Of all people to see at the bunny vet!

So, he has a semi-clean bill of health!

 

[Maureen Las]

Are you still giving the medications other than metacam ?

 

[kherrmann3]

Yup. I just add the Metacam in with the other three. I give four meds at 6:00am, two at 2:00pm and three at 10:00pm. I can't keep all of these syringes separate! Ugh!

 

[myheart]

Poor little Toby.... Sorry for not catchingyour threadsover the weekend. You must have awefully worried to have gone to the emergency vet. Probably a good thing you decided to go to be on the safe side.

Now that you are a professional at sub-q's, want to give me a hand from time to time? :cry2Luna and I are doing better at it, but we still have our days when more than one stick happens and I get to feel horrible for the rest of the day about hurting her more than I should have to.

Glad to hear Toby is doing better! :biggrin2:

myheart

 

[Maureen Las]

kherrmann3 wrote:

Yup. I just add the Metacam in with the other three. I give four meds at 6:00am, two at 2:00pm and three at 10:00pm. I can't keep all of these syringes separate! Ugh!

I accidentally found this when I was lookingfor something else on rabbit references and although I hate to post it I feel obligated to. Metrinadazole and cispaprideare not compatible drugs . I wouldn't worry about it now but call your vet tomorrow

http://homepage.mac.com/mattocks/morfz/Interaction.html

 

[kherrmann3]

When I handed Dr. Bloss the discharge packet that the ER gave us, she said that everything was OK. Would the dosages affect that? Like, in small amounts, they're OK, but large doses aren't? It also says "possible" interaction in that article. I mean, I would rather be safe than sorry, but could they mean it like human birth control pills can "possibly" cause blood clots? I'm curious now... *scampers off to the interweb*

 

[kherrmann3]

myheart wrote:

Now that you are a professional at sub-q's, want to give me a hand from time to time? :cry2

I'm hardly a pro! Last night, we tried to do the sub-q fluids and I accidentally stuck the needle through the other side of the skin and shot the fluids all over Will! We stopped there. We weren't trying again. I felt terrible. We would stop after two sticks. I would push for half the fluids. Once that was in, I was satisfied!

 

[Maureen Las]

kherrmann3 wrote:

When I handed Dr. Bloss the discharge packet that the ER gave us, she said that everything was OK. Would the dosages affect that? Like, in small amounts, they're OK, but large doses aren't? It also says "possible" interaction in that article. I mean, I would rather be safe than sorry, but could they mean it like human birth control pills can "possibly" cause blood clots? I'm curious now... *scampers off to the interweb*

I don't really know anything about it except I saw it and thought that if something did happen that I would feel guilty for not posting it.
it 's possible thatproblems have occurred a few times I really wishI knew but I don't

 

[Maureen Las]

I found another warning and several other references. ; this is human subjects but I still would be concerned
http://www.drugs.com/drug-interactions/flagyl_d00108_propulsid_d03166.html

 

[tonyshuman]

Yikes. I skimmed the link Maureen posted yesterday, but reading it more in depth today has me a bit worried.

What it's saying is that metronidazole inhibits the enzyme that breaks down cisapride, and this can lead cisapride to cause heart problems. I guess it can be like a cisapride overdose because the mechanism to remove it from the system is shut down or at least reduced. You may want to mention this to your vet. It's a pretty big deal, I think, but it depends on where you are in the so-called therapeutic window of the cisapride.

So every drug has a minimal effective dose, which is the amount you need to see any of the desired effects. It also has a dose at which undesirable (side) effects start to show up. The range between these doses is called the therapeutic window. If you are giving Toby a dose at the low end of the therapeutic window for cisapride, adding metronidazole to the mix is less likely to bring the amount of cisapride in his system up into the side effect dose range. If the dose you're giving him is already at the middle or high end of the therapeutic window, adding metronidazole could cause some of those dangerous side effects.

It sounds like something your vet may already know, since CYP3A4 inhibitors are common and always given special attention when you tell a doctor how to go about giving the dose. The vet may have already given you a lower dose than usual because of the combination and the known interaction. You still may want to check to be sure.

I hope this made sense--I know you're health-sciences minded, so hopefully it's something you've heard of before. Let me know if you need a better explanation.

 

[tonyshuman]

I've been looking for images that describe this and all I can find is one that describes this therapeutic window concept

The idea I'm trying to get across is that cisapride reduces the body's ability to remove metronidazole, so instead of the concentration in the body decreasing in a way like it does in the studies that were conducted to determine the best way to dose it to rabbits, it sticks around longer. Therefore, it could reach concentrations higher than the therapeutic window and cause bad side effects.

 

[Maureen Las]

tonyshuman wrote:

I've been looking for images that describe this and all I can find is one that describes this therapeutic window concept

The idea I'm trying to get across is that cisapride reduces the body's ability to remove metronidazole, so instead of the concentration in the body decreasing in a way like it does in the studies that were conducted to determine the best way to dose it to rabbits, it sticks around longer. Therefore, it could reach concentrations higher than the therapeutic window and cause bad side effects.

Great info and description
Thanks Claire for making this understandable

Maureen