Cecotroph mess

[Liung]

Hey guys, since the vet is firmly closed to nonemergency cases and hates giving advice over the phone... anybody have some insight?

Starting in March, Delilah has been leaving what I’m pretty sure are cecotrophs smeared all over her favourite condo shelf on a semi-regular basis. At first it was only a scattering, once a week or so. But it’s been getting bigger and more frequent and now it seems like it’s happening every single day. This morning we woke up to a massive patty.





I’ve started giving her two spoons of critical care every night—she will happily eat it out of a bowl, bless her—but I don’t know what else to do.

She’s on some really heavy duty antibiotics right now due to being diagnosed with inner ear abscesses which tests have shown to be the highly resistant superbug MRSA. Lahi had a very sensitive tummy and would threaten to go into GI stasis every single time he was on antibiotics—a Delilah that isn’t eating, however, is a Delilah that’s being rushed to ER, because Delilah is ALWAYS eating.

So I’m hoping this is just a reaction to the antibiotics, but she’s been on them since January, and this only started in March and seems to be getting worse. Is her tummy disagreeing with the greens and veggies we’ve been giving her?? Keeping fresh greens during a pandemic is hard, but we gave her the carrot peels from when we made dinner last night, and the day before that I thoroughly washed all the salad greens that weren’t going bad and gave her those.

She gets a scattering of pellets every night in a treat ball or a slow feeder, and as much hay as her bunny heart desires. Here she is, standing on top of the 25lbs box of hay I buy, very proud of herself for making it up there.

 

[bunnylove2024]

Well, she is a beautiful bunny. I think with all the medications and other things that it might be the reason why, it kind of seems like diarrhea. I'd say take her off critical care until you see severe signs cuz Critical Care helps with digestion and she might not need that right now because she's already having an easy time. is she still pooping regularly though, besides the other poop?

 

[bunnylove2024]

Hey @Mariam+Theo do you have any ideas, you seem to know about stuff like this!

 

[Mariam+Theo]

Is this rabbit litter trained? I also think the medicine is causing her to have diarrhea. I also think you should take her off the Critical Care now that she is eating on her own because that is probably also messing up her gut. What does her diet look like?

 

[Hermelin]

I think the antibiotic have taken away the good bacteria in her intestines which is the cause for the droppings.

I would take away the veggies and just let her have hay and a fiber rich diet until the medication it’s done. Because her stomach will be sensitive while taking the antibiotics.

 

[zuppa]

Hi, I see your registration date so you're not new to rabbits may I ask what age is she and if this ever happened to her before?

Looks like cecotropes to me as well, does she also have normal poos in her toilet?

What food (name or ingredients, fibre/protein percentage) she gets now, I understood that she still gets some vegs every day as well?

Some of my rabbits have this kind of mess if their diet is too rich, if it happens I keep them on hay and water for a couple days and it's back to normal. As Hermelin said it could be also caused by antibiotics

 

[Liung]

I only put her on Critical Care three days ago after I was cleaning the condo and realized that these poops were all through the whole thing. If they are cecotrophs (which I suspect they are because her normal poops in her litter box are fine, and these are all very dark and squishy until they dry into a rock hard flat mess) then I figured that meant she was missing out on important nutrients and gut bacteria, and some critical care now would help replace what she’s not getting.

Normally she’s very well litter trained, yes, she’s had a couple instances of “hey can I make this a new litter spot?” pooping a nice pile for me in a corner somewhere with a little pee puddle, but I clean it up and she doesn’t try again, and it happens only rarely. And that’s normal, healthy round poops.

The pellets she’s on, I’d have to dig around for the nutrient analysis but it’s got a really nice analysis panel, I compared it to the breakdown that is ideal for house rabbits on The Rabbit House. The fibre content of it is VERY high, it came from my work where they free feed their rabbits pellets, and don’t feed them that much hay. Delilah only gets about a handful or two a day, scattered on the floor, in a treat ball, in the hay box...Delilah tries to inhale anything put before her in a bowl, so she always works hard for her food. It also keeps her entertained and less destructive—a bored Delilah is a Delilah who starts testing what gets a “NO!!” the fastest.

I can’t take her off the antibiotics, they’re the only things controlling the ear abscesses. After the bilateral PECA-BO surgeries failed to eradicate the infection and the abscesses returned, she was supposed to go for a revision surgery, until the CVO mandated a province-wide halt to any surgery not deemed emergency, due to the shortage in medical masks. The antibiotics already failed to prevent the abscesses from returning, but at least she has no more pus in her outer ears, so they’re at least doing SOMETHING. The antibiotics are all that is keeping the abscesses in check until we can finally get that surgery.

I don’t really know how to convince her to eat more hay, she already has two massive hay racks that stay constantly topped up, as well as a big box that’s filled with hay that I scatter pellets inside to encourage foraging behaviour. I‘ve fed her orchard grass all her life, since Timothy hay got a very “meh” reaction from all my rabbits, and also I hate hay slivers in my hands.

 

[bunnylove2024]

Try alphalph, it is very good for them and it tastes better to!

 

[zuppa]

I just love her toilet corner!

 

[Liung]

Also, Delilah is 8 years old! But she doesn’t act it, and her body shows very few signs of aging compared to how Lahi was at age 8. She hasn’t slowed down at ALL. Her eyes are slightly cloudy, and her teeth are just a tiny bit pointy in a way that has the vet recommending a dental just because “all elderbuns deserve a dental, but honestly her teeth are not that bad she doesn’t really need it”

 

[JBun]

This is not diarrhea. Diarrhea in rabbits is when the fecal poop is watery or pudding like and doesn't come out as normally formed balls. This is cecal dysbiosis likely brought on by the antibiotics disrupting the microflora balance in the cecum causing the cecotropes not to form properly. Thus they taste 'wrong' to the rabbit, so the rabbit will not consume them as they normally would.
https://rabbit.org/intermittent-soft-cecotropes-in-rabbits/
@Liung Lots of good quality grass hay is going to help the most in helping her gut to maintain the balance of microflora. So I would have her diet primarily concentrated on that, with zero sugary/starchy foods. So no carrot peels. I also wouldn't bother with the critical care. Cecotropes provide completely different nutrients than what is in critical care or pellets, so you can't really make up for her not eating her cecals, except to help get things back in balance so she can resume eating her cecals again.

You may be ok continuing the pellets provided it's just a small amount, but if this continues then you may even need to reduce pellet amounts. I wouldn't worry about the greens one way or the other. They aren't likely contributing to the problem if they are ones she's always been used to getting, but if you're having problems with keeping a supply, they aren't absolutely necessary, provided your hay quality is good.

A good grass hay really is the best thing to help accomplish getting the cecum back in balance . Most rabbit's can be fed a primarily grass hay diet and stay perfectly healthy. Provided the grass hay is the right quality, a salt lick is provided and used, and you monitor body condition to ensure a healthy weight is maintained. The link above provides all this info on using grass hay to correct cecal dysbiosis.

If you aren't also giving a probiotic, maybe consider bene bac plus. There's no definite research showing it'sbeneficial in adult rabbits, but I figure it's all you can do to try to counteract the affects of the antibiotic. It should be given several hours after and before the antibiotic is given.

What antibiotic is she on? Was azithromycin ever considered or tried (I can't remember if we've already discussed this)?

 

[Liung]

Thanks JBun! I’ll definitely poke around to see if I can find anybody with Bene bac. I’m in the same area as Rabbit Rescue, so perhaps they’ll have a stock I can purchase from so I’m not waiting a month for online shopping delivery.

I‘ll definitely cut out on the veggies and greens—I was running out anyway—but I’m not sure what more I can do to encourage her to eat more hay. As seen, she gets big hay racks next to her litter boxes, and the litter boxes themselves have a generous layer of hay on top. And I have her foraging through hay to get her pellets. I wish I could try the dried herb packets from Small Pet Select, but they won’t ship to Canada.

As for antibiotics, one mo while I dig out her medical records... but azithromycin sounds familiar, I think it’s one of the ones she was on before the bacteria culture came back MRSA.

Basically MRSA (methicillin resistant staphylococcus aureus) is resistant to almost any antibiotic that is penicillin based, so she’s on only sulfa-based antibiotics now

 

[Liung]

Okay, this took some digging but I think I have the timeline straight now.

When Delilah was first diagnosed with inner ear abscesses August 2019 after I noticed her flinching away from her ears being touched and itching at her ears, I insisted we first try Duplocillin injections, because that had cleared up Lahi’s retrobulbar abscess by itself without any further medical intervention in 2014.

That didn’t help, so in October 2019 we scheduled her first PECA-BO surgery for November, and did a head CT at the same time as she was having some skin lumps removed.

They performed the first surgery November 18th, and sampled the pus inside for bacterial culture, which came back Staphylococcus aureus and Fusobacterium necrophorum, resistant to the duplocillin, so we switched her to Azithromycin and Metronidazole, and booked the next surgery for December.

December 9th was the second PECA-BO, and we did another culture, which came back again Staphylococcus aureus and Fusobacterium necrophorum, but now resistant to Azithromycin. She was switched to Sulfamethoxazole & trimethoprim (TMS) on top of the Metronidazole.


January 24 2020, I took her for a recheck on the incisions, and pus was seen in her left ear, and some discharge in her right ear. They cultured the pus, and this time it came back Methicillin-Resistant Staphylococcus aureus and Staphylococcus simulans. She was prescribed Chloramphenicol and more TMS.

March 13 2020 I had a recheck booked, which was great because March 10 I noticed she had complete left-side facial paralysis, with no blink reflex on that side. Her third eyelid was moving to cover the eye instead, but she had no functionality in her face, and it was very obvious from how droopy her face was.



She was prescribed Meloxicam in the hope that the paralysis was due to inflammation pressing on the vestibular nerve, as opposed to damage to the nerve, and a couple weeks later she seemed to have full muscle tension back.

During the March recheck, no pus was found in the outer ear, which was the first real good news I’d had this entire time. But the CT scan showed obstruction in both ears, and that the PECA-BO surgeries had failed.

The vet explained that they did the less aggressive PECA-BO surgery, because the more aggressive is less likely to have the infection recur, but much more likely to accidentally hit the vestibular nerve and cause the very neurological symptoms the surgery was intended to prevent. Delilah is officially the second ever rabbit at the OVC to have abscesses recur after the less-aggressive PECA-BO. So the next step should be to do a revision surgery with the more aggressive version.

But just as we were about to schedule the revision surgery, the CVO sent out a province-wide ban on “elective” surgeries due to the mask shortage. Emergency surgeries only.

Her infection has been getting more and more resistant and it’s honestly terrifying. I don’t THINK she could have personally managed to have Staph. aureus mutate into MRSA all by herself... but Lahi managed to develop a novel form of malignant rabbit cancer a year after he finished surviving a rare form of malignant rabbit cancer, so really I would believe anything of these guys.

 

[Mariam+Theo]

Wow! All that medicine must be costing you a ton of money! I don't really understand any of that, but I know JBun will, and she will be able to help you

I saw how JBun recommended Bene-Bac Plus, and I think you should give it to her! I got some for Theo when he kept getting symptoms of stasis and it knocked it out! I got the powder because it was cheap, easy to use, and it came with a lot! He got some every other day for a week with his veggies. The way I would give it to him is by washing his lettuce and dipping the end of the lettuce (not the leafy side) into the power until the line was an inch up the lettuce (sorry if that makes no sense). He ate it with no problem!

 

[Lyn1971]

Hey guys, since the vet is firmly closed to nonemergency cases and hates giving advice over the phone... anybody have some insight?

Starting in March, Delilah has been leaving what I’m pretty sure are cecotrophs smeared all over her favourite condo shelf on a semi-regular basis. At first it was only a scattering, once a week or so. But it’s been getting bigger and more frequent and now it seems like it’s happening every single day. This morning we woke up to a massive patty.

View attachment 46159
View attachment 46160
View attachment 46161

I’ve started giving her two spoons of critical care every night—she will happily eat it out of a bowl, bless her—but I don’t know what else to do.

She’s on some really heavy duty antibiotics right now due to being diagnosed with inner ear abscesses which tests have shown to be the highly resistant superbug MRSA. Lahi had a very sensitive tummy and would threaten to go into GI stasis every single time he was on antibiotics—a Delilah that isn’t eating, however, is a Delilah that’s being rushed to ER, because Delilah is ALWAYS eating.

So I’m hoping this is just a reaction to the antibiotics, but she’s been on them since January, and this only started in March and seems to be getting worse. Is her tummy disagreeing with the greens and veggies we’ve been giving her?? Keeping fresh greens during a pandemic is hard, but we gave her the carrot peels from when we made dinner last night, and the day before that I thoroughly washed all the salad greens that weren’t going bad and gave her those.

She gets a scattering of pellets every night in a treat ball or a slow feeder, and as much hay as her bunny heart desires. Here she is, standing on top of the 25lbs box of hay I buy, very proud of herself for making it

 

[Lyn1971]

Hi I'd cut her greens down and give her alfalfa hay. I'd also put a good supplement in her water.

 

[Hollandblaze03]

I am having a similar problem with my doe except she isn’t on any medications. She is shedding and some of her poops are strung together.

 

[JBun]

@Liung I'm just amazed at all you've been through with your rabbit's over the years, and how well you've handled it all. You've had so many unusual medical issues that you've had to deal with.

That's so difficult that you're down to not really having any effective antibiotics left to use. I'm glad this is at least keeping the external signs of infection in check. Hopefully things will settle down soon so you can get the procedure done to help her.

 

[Blue eyes]

Try alphalph, it is very good for them and it tastes better to!

Hi I'd cut her greens down and give her alfalfa hay. I'd also put a good supplement in her water.

Alfalfa hay is a legume, not a grass hay. It is appropriate for very young rabbits but is too rich to feed adult rabbits. The richness of legumes is particularly not a good idea for a rabbit having excess cecals. Grass hay, as Jbun suggested, is the best for adult rabbits generally but especially those with any GI issues.