Burst or ulcerated tumor 10 year old rabbit

[OliveGooseberry]

Hi. My sweet girl Olive is a little over ten years old. Yesterday I found a lump near her leg joint while I was grooming her. The skin/fur easily came off and there appeared to be a wound.

I took her to the emergency vet and they discussed aspiration and an X-ray to determine what it is and if it made it to the bone. They would then amputate her leg.

This is not something I am willing to have done to her. Her age worries me as far as anesthesia is concerned and it is not something I am willing to risk.

She is not in pain, moving as normal (just a little struggle for her to get in and out of poop box) but she’s still eating and still coming out into the house for her dinner.

I’m taking her to the vet tomorrow to discuss what her options are outside of surgery. Could the X-ray results really do much in terms of palliative care? I want to know what I can do to help her heal externally. I know this might be end of life.

Has anyone experienced this before? What have you done? What can be done without surgery. I want to treat my sweet girl with the love and respect she deserves without subjecting this sweet, old buns to unnecessary stress.

I’d appreciate any info, comment, help.

Here is A PHOTO of The ISSUE….

https://ibb.co/FbScKkLp

Please copy and paste the url. I cannot seem to get it to insert in the post.

 

[JBun]

Here is A PHOTO of The ISSUE….

https://ibb.co/FbScKkLp

Please copy and paste the url. I cannot seem to get it to insert in the post.

It'll be better for you to have the photo here visible in a post, instead of a link, as some may not be comfortable clicking on an external link.

If you don't have the picture saved to your phone or computer, screen shot it and then save it. Then you can click the 'Attach files ' box that's right below the reply box. Then select your picture file from your device, and it will download the attachment into your new post.

 

[JBun]

If it's a burst abscess, the way abscesses often are with rabbits, it's very possible that it may not have spread to the bone or anywhere else yet, as they can be encapsulated and walled off, at least until it bursts.

https://www.medirabbit.com/EN/Skin_diseases/Bacterial/Abscess/skin_abscess.htm

Presuming this is a burst abscess and not another skin condition, the xrays may show if the infection has spread to the bone. But if you're certain you don't want to go the surgical route and anesthesia, whether that's amputation or surgical removal of the abscess pocket, then it'll be up to you whether you want xrays or not, as having them done may not change the treatment path, which would be non surgical wound management and antibiotic treatment.

https://www.medirabbit.com/EN/Skin_diseases/Bacterial/Absc_treat/abscess_treat.htm

But if it has spread to the bone, antibiotic treatment should be very aggressive. So xrays may help in that regard, for possibly knowing how aggressive antibiotic treatment needs to be. But that's only if the xrays have conclusive results, which sometimes they won't. And then there is the culture and sensitivity test if you want to know the bacteria involved and what antibiotic is best to treat it. Or not have it done and just monitor the effectiveness of whichever antibiotic is initially started. Though if you aren't seeing improvement in the first week, it's likely not effective and the antibiotic will need to be changed.

I had a rabbit that developed an abscess in her ocular orbit after she had eye removal surgery, and this abscess burst. Treatment was daily flushing of the abscess pocket to keep the pus cleaned out. And antibiotics were initially baytril, then another (can't remember), but the infection kept returning. So we switched to a more 'heavy duty' antibiotic, azithromycin. Which was extremely effective. But the infection returned after the 2 week treatment was stopped. So a higher 50mg/kg dose was given, and for a longer 3-4 weeks. The infection cleared up completely and didn't return.

I've had really good results with azithromycin. It penetrates bone and tissue really well, and worked quickly in reducing infection and symptoms in 2-3 days. But this all will depend on if the bacteria present is sensitive to it. Another thing to consider when deciding on using it, is that it may cause stomach cramping and lack of appetite, and in rare instances it may cause severe gastric upset which would require stopping the antibiotic immediately. But I only saw mild stomach cramping that mostly stopped after a couple hours following administering. Some additional info is that it seems to be best given on a mostly empty stomach prior to feeding time, and also have syringe feeding mix on hand in case bun stops eating due to possible stomach upset. So those are risks that would need to be evaluated when considering using this antibiotic.

Another common antibiotic given to rabbits with an abscess is penicillin injections. But that can be a pain to deal with as they have to be given every 1-3 days, depending on which pen g is used. And you have to be extremely careful about leakage at the injection site, as any penicillin left on the skin and in the fur, risks being groomed off by the rabbit, which can result in fatal enterotoxemia. It can be a really effective antibiotic (injection only), but care has to be used to keep the rabbit safe from any oral ingestion.

If there's a significant risk the infection has in fact spread to the bone, my personal preference would be to try azithromycin (if the bacteria is sensitive) despite the gastric risks, due to how effective it can be at penetrating infection quickly. The risk of osteomyelitis from the infection would outweigh the stomach upset risks to me. Just my opinion.

 

[OliveGooseberry]

Thank you very much for all of this information!

If it's a burst abscess, the way abscesses often are with rabbits, it's very possible that it may not have spread to the bone or anywhere else yet, as they can be encapsulated and walled off, at least until it bursts.

https://www.medirabbit.com/EN/Skin_diseases/Bacterial/Abscess/skin_abscess.htm

Presuming this is a burst abscess and not another skin condition, the xrays may show if the infection has spread to the bone. But if you're certain you don't want to go the surgical route and anesthesia, whether that's amputation or surgical removal of the abscess pocket, then it'll be up to you whether you want xrays or not, as having them done may not change the treatment path, which would be non surgical wound management and antibiotic treatment.

https://www.medirabbit.com/EN/Skin_diseases/Bacterial/Absc_treat/abscess_treat.htm

But if it has spread to the bone, antibiotic treatment should be very aggressive. So xrays may help in that regard, for possibly knowing how aggressive antibiotic treatment needs to be. But that's only if the xrays have conclusive results, which sometimes they won't. And then there is the culture and sensitivity test if you want to know the bacteria involved and what antibiotic is best to treat it. Or not have it done and just monitor the effectiveness of whichever antibiotic is initially started. Though if you aren't seeing improvement in the first week, it's likely not effective and the antibiotic will need to be changed.

I had a rabbit that developed an abscess in her ocular orbit after she had eye removal surgery, and this abscess burst. Treatment was daily flushing of the abscess pocket to keep the pus cleaned out. And antibiotics were initially baytril, then another (can't remember), but the infection kept returning. So we switched to a more 'heavy duty' antibiotic, azithromycin. Which was extremely effective. But the infection returned after the 2 week treatment was stopped. So a higher 50mg/kg dose was given, and for a longer 3-4 weeks. The infection cleared up completely and didn't return.

I've had really good results with azithromycin. It penetrates bone and tissue really well, and worked quickly in reducing infection and symptoms in 2-3 days. But this all will depend on if the bacteria present is sensitive to it. Another thing to consider when deciding on using it, is that it may cause stomach cramping and lack of appetite, and in rare instances it may cause severe gastric upset which would require stopping the antibiotic immediately. But I only saw mild stomach cramping that mostly stopped after a couple hours following administering. Some additional info is that it seems to be best given on a mostly empty stomach prior to feeding time, and also have syringe feeding mix on hand in case bun stops eating due to possible stomach upset. So those are risks that would need to be evaluated when considering using this antibiotic.

Another common antibiotic given to rabbits with an abscess is penicillin injections. But that can be a pain to deal with as they have to be given every 1-3 days, depending on which pen g is used. And you have to be extremely careful about leakage at the injection site, as any penicillin left on the skin and in the fur, risks being groomed off by the rabbit, which can result in fatal enterotoxemia. It can be a really effective antibiotic (injection only), but care has to be used to keep the rabbit safe from any oral ingestion.

If there's a significant risk the infection has in fact spread to the bone, my personal preference would be to try azithromycin (if the bacteria is sensitive) despite the gastric risks, due to how effective it can be at penetrating infection quickly. The risk of osteomyelitis from the infection would outweigh the stomach upset risks to me. Just my opinion.

 

[OliveGooseberry]

Here is a photo - it was taken right after the skin/fur came off. It is no longer wet or bleeding. She was given topical cream and it has started to dry out.

It'll be better for you to have the photo here visible in a post, instead of a link, as some may not be comfortable clicking on an external link.

If you don't have the picture saved to your phone or computer, screen shot it and then save it. Then you can click the 'Attach files ' box that's right below the reply box. Then select your picture file from your device, and it will download the attachment into your new post.

 

[OliveGooseberry]

do you know if Meloxidyl will make her lethargic? They prescribed it to her.

 

[JBun]

That to me that looks more like a possible skin tumor, provided pus wasn't just cleaned off previous to the picture being taken. A burst abscess won't usually look like that, and is unlikely to be bloody like that. It will more often be coated in gooey pus, or almost a cement like substance when dried.

https://crossriggsvets.co.uk/pet-factsheets/?Rabbits&factsheets-types=bGFwaXM=&nodeguid=117690

https://www.medirabbit.com/EN/Skin_diseases/Bacterial/Abscess/skin_abscess.htm

It does also possibly have the appearance of a botfly, especially if that dark spot in the picture is a hole in the middle of the lump. A botfly will create a circular external lump on the skin, similar to what a skin tumor may look like. So just a possibility to rule out.

https://www.medirabbit.com/EN/Skin_diseases/Parasitic/Cuterebra/Miyasis_botfly.htm

If it is a tumor, you'll have to evaluate if surgical removal is something you want to risk due to requiring sedation. The vet can try to get a sample without sedation, to send to the lab to see if it's cancerous, if you want that info. If it is cancerous, then it's likely worth the risk having it removed. If it's not cancerous and isn't causing any significant problems for your rabbit, it's something I probably wouldn't risk removal with in the circumstances, and would just leave it for now and continue to monitor it.

If surgery is necessary, my suggestion would be to find the best rabbit vet around, even if you have to make a bit of a drive. A really experienced rabbit vet will increase chances of a successful surgery, especially dealing with an older rabbit. Which would include making sure a blood panel is done to ensure your rabbit has good kidney and liver function going into the surgery.

https://wabbitwiki.com/wiki/Choosing_a_rabbit_veterinarian

https://wabbitwiki.com/wiki/Florida

do you know if Meloxidyl will make her lethargic? They prescribed it to her.

It shouldn't normally, unless there's an underlying problem or negative reaction to the med. Which, though unusual, can happen. Meloxicam isn't a narcotic, just a normal NSAID, like Ibuprofen, but safer for use with rabbits. Though just like when we take NSAIDs, it needs to be taken with food and water. So the rabbit should have something in It's stomach and needs to be drinking well.

Counter indicators for not giving Meloxicam would be if your rabbit is already on other NSAIDs or corticosteroids, is dehydrated and not drinking, has kidney issues, or has or is showing signs of gastric ulcers, which could all result in a rabbit being lethargic and acting unwell after receiving the med. If your rabbit is acting unusually lethargic after you started the med, please contact your knowledgeable rabbit vet right away, as there may be a sensitivity or negative reaction to the medication.

https://rabbitwelfare.co.uk/drug-focus-meloxicam/