Dental disease in an older rabbit

[DazyDaizee]

My rabbit, Pete, is estimated to be 7-9 years old (I adopted him last August). Recently he started drooling, we took him to the vet and found out his molars were overgrown and had points. He was sedated and the teeth were filed. There was some pus in the mouth but no obvious extractions were needed.

He did not recover well and boarded with the vet for a week while I was away. When I got home he was doing worse and I found a lump under his chin. I brought him back to the vet and FNA confirmed an abscess. Back under anesthesia for Pete. The abscess was lanced and flushed out. There was another abscess inside the mouth which was also lanced and drained. One molar seemed to be linked to one abscess, so that tooth was pulled. They took xrays and pulled one other problem tooth. This was done on Thursday. It is now Saturday and he is still not doing well.

He tries to eat but cannot. I am syringe feeding him baby food since that's all he's interested in. He's on pain medication and antibiotics. I just picked up a vitamin today since I'm worried he's not getting adequate nutrition and he won't eat soaked pellets or Oxbow Critical care. I am mixing different baby foods, trying to balance out what he's getting in some way. I got veggie, oatmeal, and a few fruit baby foods. I mix them with water and syringe feed him. He won't eat a lot and physically cannot eat on his own. I'm feeding him 3-4 times a day and flushing his mouth out afterwards.

I guess I'm wondering if there's anything else I can feed him, any tricks others have used. He has an appetite but his mouth just doesn't seem to work the way he wants it to. The only way I can get anything into him is if it's liquid consistency and I use a syringe to get it into the back of his mouth. I added a probiotic (worried his gut will act up) and now the multivitamin... are there any other supplements I should be adding??

Has anyone else had a rabbit like this that has recovered? The vet said that about 50% of rabbits with these problems recover and do well, while the other 50% tend to have recurring abscesses and dental issues and often times do not ever recover. I just feel horrible and wonder if I'm doing the right thing. He makes these heartwrenching groans when I pick him up... he's very inactive, he has a head tilt which has been going on since he first had the dental problem... I adore him and I don't want to give up on him.. he just seems to miserable that it's killing me to watch him suffer and I wonder whether I'm putting him through too much.

He's supposed to go for a recheck on Monday and to have the packing changed where the abscess under his chin was, but I'm going to call tomorrow to see if I can get him in then instead...

 

[Maureen Las]

I have been though dental issues that were severe with a much younger rabbit. he had 6 teeth pulled last fall and had a very difficult recovery. he did not, however , have abscesses which makes this more complicated and painful. I did not do well trying to feed him critical care and learned that it had to be watered down a lot in order to get a very thin consistency. I relied a lot on pure Canned and unseasoned pumpkin which he did like . He practically lived off cherry flavored pedialyte andI mixed probiotics with it to try to resestablish his GI tract. He did eat some on his own, however, which made it easier than what you are dealing with. You can get a product called Nutrical which is a marketed as an appetite stimulant for dogs and cats and is high in vitamins and nutrition , however he may have difficulty withthe consistency of it. I have not had good luck with baby food but if your bun eats it it is fine.
First of allI think that your bun is not receiving an appropriate amount of pain meds. If he is just getting mmeloxicam this is not enough to cover the amount of pain that he is feeling

Do you have a rabbit experienced vet. this is vital in treating something as complicated as jaw and mouth abscesses.

Your bun should be receiving strong antibiotics.

Our expert , Randy, has treated many abscesses with the use of two strong antibiotics.. one of them is bicillin which is a combination of procaine G penicillin (short acting and benzathine penicillin. (long acting) . This drug is given by subqutaneous injection every other day (penicillin can never be given orallly). An oral med will also be given . usually something like zithromax or chloramphenical

Sulfa drugs and enrofloxicins are not strong enough for these kinds of issues.
You need a good vet, strong antibiotics and good pain management


Even with that taken care of you need to evaluate the quality of our rabbit's life. maybe better pain management will make him comfortable enough to eat better . he is not a young guy so that is something that you need to evaluate.
But first focus on pain management and the antibiotics

Is your vet up to par?

Do what you can do and when it is done your rabbit will let you know what he wants..
i will give you some links from our library
some of them are not as up-dated as what I am telling you in terms of meds etc. be sure to read the thread re. Bon and Gizmo?Gizmo put up a good fight but it was his time.

please post more info and we will help as best we can

http://www.rabbitsonline.net/view_topic.php?id=11791&forum_id=10

Maureen

 

[naturestee]

Hi,

Could you tell us the pain meds and antibiotics he's on? Some vets will only give Metacam, which is a mild anti-inflammatory, but for big dental work like that and since he's not eating he might do better with something stronger like Tramadol or a good, strong opiate. Some of these can be given in combination with the Metacam too. Same for the antibiotics- some vets will go for the traditional "safe" medicines like Baytril first although it tends not to work well any more (drug resistant bacteria).

I do recommend canned pumpkin. Most of my permanent and foster buns have loved it. Sometimes they'll lick it off a lettuce leaf if they won't take it from a spoon or bowl. Also, Critical Care comes in two flavors. The good one is apple/banana, the other one is anise? Strong smell, generally unpopular. You can also add a little mushed banana, pureed carrot, etc if he likes that. The tiny broken leaves from a bag of alfalfa are tempting, too. He might be able to lick those up.

Is he drinking? If not, make sure you're syringing some fluids to him also. A rabbit that can't/won't drink won't eat. Not to mention the stress on his body from being dehydrated.

Since it's the weekend (unless you vet is in and can do a B vitamin injection), get some Nutrical (made for cats and dogs, get the malt flavor) and put it on his paw to lick off. This will get some calories into him, plus B vitamins to stimulate his appetite and E to soothe his gut, which might be feeling off from being without food.

Jaw abscesses are very hard to deal with but not impossible. I know I've seen some full recoveries on the forum, and others where the infection was controlled and the rabbit was able to live a happy, longer span before complications or other problems showed up.

Once the infection is cleared up, you can join the Molar Spur Club with the rest of us....:twitch:

 

[ra7751]

Well....I have a few questions. First, how experienced is your vet in treating abscesses in rabbits? This is much different than would be seen in a cat or dog (or even a rat). What pain meds is he getting and what antibiotic(s) are being used. I have dealt with abscesses quite a bit....including one in a very large Flemish right now. I have had perfect success in treating them non-surgically. I do not open them. Not saying I never would....but in most cases it only causes more problems. Molar impactions and/or malocclusion are common in older rabbits or in animals that have had nutritional deficiencies. Critcal Care is often difficult to force feed and many rabbits never acquirethe taste (especially anise) or a fondness of the texture. Additionally, Critical Care can be very dehydrating in certain situations.

Abscesses are a challenge to treat. Just a few years ago, nearly every rabbit that suffered an abscess did not survive. Then the idea came about to lance the abscess and insert antibiotic laced beads into the abscess. Didn't work too well. The trick to treating an abscess is to come up with a treatment protocol using drugs that can penetrate to the core which usually contains anerobic bacteria. Few drugs that vets will use are up to the task. As mentioned, I do not open abscesses. I treat with a precise combination of Pen G (a specific combination of Procaine and Benzathine) and a high end dosing of Zithromax. This combination of drugs is very effective at getting to the core of the problem...and that is the core of the abscess. Aggressive pain meds are in order....narcotics. I offer supplemental hydration via sub-q or IV infusions daily. I have an entire husbandry protocol in dealing with the eating difficulties including stimulants to help the appetite. I have a perfect success rate on treating these abscesses without surgical intervention. My Flemish, Chyna, is well on her way to recovery. She has been the most challenging.... most likely due to her size and the way drugs are absorbed. I know my abscess protocols are effective so I stuck with my treatment protocol even when it appeared things were not going well.

Honestly, the only down side I see here is your rabbit's age and the uncertainty of his past. However I would not hesitate to use aggressive drug treatments both for the infection and secondary pain. Keep in mind that your responsibility as his custodian is to make decisions based in his best interests.....not on emotions. This is not intended to suggest making what I call "the ultimate decision" but his quality of life does need to be considered. He is in the autumn of his life and you have given him a special gift by adopting him. I would treat him as long as he is willing to fight.

I would suspect that hydration would be an issue right now. Hydration before nutrition. Get him pumped on fluids and get his hydration up. Just replacing the lost electrolytes will make him feel better. A shot of B Comp will also help. Offer canned pumpkin (not the pie filling....has to be real canned pumpkin). Critical Care can be mixed with the pumpkin. Offer high nutritional greens such as kale, dandelion greens or carrot tops if he will eat them. Get aggressive on the pain meds and that will also help his appetite.

There is one huge concern I have and this leads me to question your vet's knowledge about rabbits.....and I hope this concern is unfounded. But you mentioned that it appeared that one molar was involved in the abscess and that it was extracted. It is not proper medical practice to extract only one tooth. A rabbit's teeth are open rooted and will continue to grow. In all rabbit dental extractions, the opposing tooth should always be extracted. That means that if you pull one incisor, you should pull all three in that particular socket in both upper and lower arcades (in reality, you should extract all six incisors if either set is involved).....molars should be extracted both upper and lower in same socket location at the same time. Failure to remove the tooth opposite the one being extracted just walks you into more dental surgery in about a month or so.

I would suggest checking out the site for a fantastic rescue in RI as they have vet listings for your area. Google "Sweet Binks" and read their site or call them and ask for a veterinary referral.

Randy

 

[tonyshuman]

Some really good advice already. I wanted to add a few foods you can feed to a bunny that won't chew or eat on his own. You can put a variety of veggies in a blender and make a fresh vegetable "pesto" that he might like. Nutri-cal is good (a high calorie supplement and appetite stimulant), and so is Oxbow Critical Care. Canned pumpkin too. Good luck!

 

[cmh9023]

Hi,

Sorry to hear about your bun. It's so hard to see them sick . You've already gotten great advice from all the experts. I just wanted to share that I had a girl who had a really bad abscess in her jaw. You asked if anyone had a rabbit who got better so I thought I'd share her story.

I would say that Sherry definitely got better, but it was a long road to recovery. She started with a small little bump on her jaw that got huge practically overnight. I took her to the emergency vet and they basically did some triage. I was lucky because their exotics vet was on duty that night. Later, she saw a veterinary dentist for surgery. I think surgery goes against what Randy does, but I hadn't read Randy's posts until after her surgery was already done. She was in surgery for 4 hours. I think because the abscess got into her jaw bone (?). She also had her molars removed.

They sent her home with only Metacam for the pain which seemed kind of ridiculous since her little jaw had just been pried open for 4 hours. I read Randy's posts and called them back and insisted she needed more and per Randy's (I think) suggestion Iasked forBuprinex (?). That seemed to be really good for her pain. She also got an injection of Procaine every other day. That was quite miraculous. I would definitely recommend getting that. It was pretty easy to give her the shots, but I gave them for quite a long time. I think she also had an oral antibiotic.

It was a little tough for her to eat for a few days, but I set out a buffet of her favorite things every day, all of which others have mentioned, and she would find something she'd like. It was usually pumpkin. After a week or so she was able to eatas thoughnothing had ever been wrong...pellets, hay, veggies. I also gave her Nutrical and Pedialite. Basically everything that the others have already talked about.

Anyway, the vet dentist said her prognosis was uncertain and probably not good for the long term. He also thought she would probably need more dental work at some point. However, at her follow up visit he said her recovery was quiteremarkable and she never needed any further dental work.

Sherry lived for another year, however her death had nothing to do with the jaw abscess. She was 8 yrs old and had been in poor health for a while. Had she been younger and in good health, I think she could have lived for a long time after the jaw problem.

But, seriously, the injections were like a miracle.

I hope your bun gets better and if you have any questions about Sherry's treatment, let me know. I have notes from the vet dentist. I'd just have to find them.

Cara

 

[DazyDaizee]

Thanks for everyone's comments.

I went to the vet today and Pete has lost about 10oz. He was very dehydrated. I gave him SQ fluids and will do the same tomorrow. They changed the packing in the incision under his chin. They gave him Buprenex, and gave me additional injections to give to him.

There is a culture and sensitivity pending so we'll know to change the antibiotic if needed, but so far there was no pus in the incision which is good, I guess.

I picked up some Apple/Banana Critical Care, but he's not so into it as he used to be. I mixed that with baby food and got about 15cc into him... about half of what I'd like to see him eat. I have been syringing some water, too, which he likes but does have difficulty swallowing it.

I have nutrical and will try giving him some. I have canned pumpkin for my sick ferret and will try giving him some of that as well.

To make things a little easier:

-CURRENT MEDS: Baytril (twice daily), Buprenex (just started today, giving 2-3 times SubQ daily), Metacam (once daily).
-Supplements: Multivitamin, Probiotic. Will add nutrical.

FOOD:

-Veggie and oatmeal baby food, Apple/Banana Critical Care, Fresh lettuce/dandelion greens/green beans/parsley (he can't really eat these chopped, but I will try to puree them in the blender and see if he likes it), I will add pumpkin.


QUESTIONS:
-Vitamin B12 injections. I actually have a few syringes of vitamin B12 for my ferret with IBD. What is the dose for a rabbit? The syringes are 0.1mL. My rabbit now weighs 5 lbs 13oz.

Concerns:
-The vet. Yes, they pride themselves on their abilities and they routinely care for exotics. However, I worked there for 2 years previously and had my doubts. I have been looking into other vets, but where this came up on a sort of emergency basis, I went to this vet because I trusted they could handle the situation. I am now left wondering whether I made a bad choice. I am not sure if it's best to see another vet now, in the middle of this issue, or to wait until he's stable.

-I have HUGE concerns about the teeth that were extracted. I know that the corresponding teeth should be taken out and maybe it's been fear on my part that caused me not to question the vet on this to find out exactly which teeth were taken. I had a hamster who was missing his two bottom incisors and it caused his top two to overgrown continually and eventually had to be extracted, so I know first hand what this is like. At this point I'm terrified of him going back under anesthesia, so I really hope that if he recovers that this does not become an issue... but I know it's likely a big problem.

-I will look into the website and see if I can find a better vet in the area to contact and perhaps switch his care to.


CURRENTLY:

I am overwhelmed. I feel horrible because I feel that I'm putting him through all of this for nothing. I have a strong feeling that he's not going to make it. At the same time I have a lot of guilt knowing that I put him through the surgery and I have to give him a chance. If I had known how poor he'd be doing, I most likely would not have done the surgery. Perhaps it was the stress of the day at the vet, but he looks like he's going to die. His head tilt looks worse and he tries to eat, then I see him laying face first, looking unconscious in his plate of food. Every time I walk into the living room I stare to see if I can see him breathing. His breathing is a little heavy and he seems absolutely miserable, despite the addition of the Buprenex.

He's due for an injection of the Buprenex now... I'm not sure if it's going to benefit him or make him worse.. but I guess I'll give it to him so at least he won't be as painful.

 

[Maureen Las]

It sounds as if you are doing everything in your power to help him

I would question the antibiotic as not being strong enough , however, you do have a culture and sensitivity pending .

If he respnds to the buprenex we may be able to help you with a better antibioitc
I am hearing what you are saying very loud and clear re. his misery.


Aftermy holland lop's major dental surgery I thought he would die from the stress of it and I would never have him put through anything like that again.

When you evaluate what to do re.your buns future try to think just about his quality of life and /or potential quality of life and attempt to remove the guilt factor . I know this is much easier said than done.
I am sensing that your bun has no good quality of life at this point and maybe this is not what I am sensing but what you are telling us.
I would see if he improves at all on the buprenex .

it is Vitamin b complex and not vitamin b12 ; I bought minein an injectable vial from a vet supply store online . I believe the dosage (Randy correct me if I am wrong) is 2 mg /kg

there is no way to assess the dosage in the ml syringes unless you know the mg per ml.

I think your bun is suffering right now from pain and most of us would not recommend baytril as a drug of choice (we are not vets) so deal with thr pain and rehydrating first and see how he does.
We can goone day at a time

"Hugs" and ray:

Maureen

 

[naturestee]

:hug:

It can be really, really tough, but you'd be surprised what rabbits can live through and come out ok. I had a round-the-clock death watch on my Dora (several times actually) and she's great now. She has more lives than a cat. When rabbits want to be, they're stronger than they realize.

One thing to add to your care routine, if you're not doing it already- heat. My favorite is a product called a Snuggle Safe, a microwaveable heating pad for animals that lasts for many hours. You can find them at Petsmart with the dog bedding, and probably at a lot of other stores too. If you don't have one on hand, fill a sock with dry rice, microwave it, and offer that. Some people like to throw a towel in the dryer for a bit and use that, but it doesn't last as long.

15 ccs of food actually is good. I can hardly get any in my buns! Some just don't take to syringe feeding. As long as he got something down, it'll keep his gut functioning.

If you feel uncomfortable about your vet, don't be afraid to look around. Second opinions are fairly common and are a good idea. The current vet clinic can fax all his records to any new vet. Just because someone says they're good at something doesn't mean they are, and vets are very much included in this.

Vent all you want here. Some of us have been in your shoes and we can sympathize.

ray:

 

[DazyDaizee]

So I think the pain meds are helping... but I'm also hoping it's the sedating effect that's causing him to lay face down in his food dish and barely move.
He is trying to eat a little on his own. I mashed up some banana (which is usually his favorite and he was trying to eat some), gave him some canned pumpkin, and chopped up some greens. He still wants nothing to do with the Critical Care, but he ate about 9cc of pumpkin mixed with water.
He got his buprenex, metacam, SQ fluids, vitamins, probiotics, and baytril this morning.

I was definitely happy to see him go over to the food dish and at least attempt to eat. I guess I'm taking that as a sign that he hasn't totally given up yet and maybe there's a little hope he'll pull through and at least have some good days left.

 

[Maureen Las]

It does sounds like the pain med is helping..; they will not eat if they are in pain. It must be really hard to see him lying in his food ; hopefully he will show a little more improvement soon.
'Hugs ray:

Maureen

 

[DazyDaizee]

I forgot to mention that yes, I do have a pink heating disk and I did put that in with him. He will lay on the blanket on top of it, so hopefully the warmth helps, also.

 

[tonyshuman]

It sounds like you're doing a great job for him. I wanted to add that Buprenex is an opiod analgesic and commonly "zonks out" a rabbit (or a person) so that may make him very lethargic. Of course you don't want him lethargic to the point of respiratory depression, but being a bit "out of it" is probably ok. He may just not want to eat due to the soreness of his mouth and some GI upset that can come with most pain meds, and he coule be frustrated by this big plate of food he's supposed to eat but doesn't want to. Give him time, and syringe food into him when you can without getting him upset.

Right now it's really important that he's hydrated due to the medications he's on. I think that should be a big priority. Syringing him water, giving him sub-q's, offering water in a bowl and in a bottle (with tooth pain his preference for bowl/bottle may have changed), and offering unsweetened pedialyte can help. Metacam can cause some damage to the kidneys if the rabbit's dehydrated.

I too am a bit concerned that Baytril isn't stong enough, but I think you want to get his pain under control. I actually have a question for Angieluv and naturestee on the wound packing--is it normal to put packing in an abscess that has been operated on? I know it's common procedure for dogs and cats (and people), but I thought it wasn't the best way to heal a rabbit's abscess. :shrug:

Heat is great, and I think you're feeding him great. The pain management meds are good--buprenex will treat the pain and metacam will treat pain to a lesser extent but is better at bringing down swelling. Huge hugs to you both--you can make it through this. When bunnies feel crummy, they can act really sick and look even worse--they don't want to groom themselves, etc. Is Toot his bonded buddy? If so, I'm sure he/she would be a great comfort to Pete.

 

[DazyDaizee]

I wondered about the wound packing, too... I've seen drains in rabbits before, but not packing... and I wonder if that is making him more uncomfortable.
Toot and Pete are buddies. The first few nights I put her in the pen with Pete, hoping they'd be happier together. She has been ignoring him (they usually follow each other around and she grooms him constantly) and eating all his food. I still give them some time together, but Pete seems too out of it to really realize she's there, and she seems indifferent. It's easier for me to see how much Pete is eating and eliminating without her in the pen. They are both used to being free range, so though Pete's separated with the pen, they can still see each other and be in close proximity.

 

[tonyshuman]

Oh ok. It's good that they can still see each other. If she were grooming him and paying attention to him, it would be good to keep them together, but I can see how keeping them apart makes it easier to keep an eye on him.

 

[naturestee]

I've seen packing and antibiotic beads mentioned in some articles on rabbit abscesses. Now, it's morepopular to treat with injected antibiotics such as Bicillin and not open up the abscess at all.

I definitely agree that the painkillers can make him loopy. But loopy isn't bad when you need pain meds that strong anyway.

 

[tonyshuman]

I guess if there's packing there for only a little while until it starts to heal up, it might be ok. This abscess kind of needed to be opened because it involved tooth roots so the teeth were damaged and needed to be removed. When a tooth gets an infection it's best to just take it out because there's so little blood flow into a tooth that it won't heal very well. That's my opinion, though, not having any experience with abscesses.

 

[Maureen Las]

I think that I've heard ( but not from Randy) but from reading various accounts of abscesses (done correctly or not :?)
of rabbit abscesses being left opened and flushed daily with a antibiotic wash as an attempt to kill all the bacteria

this is probably not necessary when a bun is on the stronger antibiotics which are able to do the job themselves

I have never heard of packing other than antibiotic beads (but that doesn't mean anything) other than they want to keep the wound open
where exactly is the packing ?

Inside the mouth and under the chin?
How is he?

 

[DazyDaizee]

The packing is under his chin. The abscess inside his mouth was left open without any packing. The packing itself seems to be gauze soaked in .. something? They mentioned nothing about antibiotic beads or anything, I read about that after he had it done, though.

Right now he is not doing well. He's making a lot of noise breathing and having difficulty. I can't tell if it's drool because he's laying on one side of his face or if there is actually discharge from one side of his nose. His whiskers are forward and you can see his abdomen move while he breathes.

I called the vet and they recommended not to give the buprenex tonight. I offered him some food and he was interested in eating, but he seems extremely weak, his head tilt is really bad, and his breathing worries me. I'm afraid to even take him to any vet tonight because first, I don't think he'd survive the car ride, and second I don't know what they would actually be able to do.

I have a nebulizer for my rat with chronic respiratory disease, so I tried nebulizing him with saline and mucomist, though I don't think it'll make a difference. We also have a stethoscope, so we listened to his lungs, but it's difficult to tell whether the noises we hear are actually coming from the lungs or just upper respiratory.

I plan to take him to another vet for a second opinion tomorrow if he's stable enough. I just don't think that it's worth the stress on him to leave him at an emergency hospital tonight.. and from my discussion with the regular vet it didn't seem like there were many other options left...

 

[Maureen Las]

He really sounds bad DazyDaizee
I hope that he makes it through the night ..
But you are doing everything that you can
I feel so sad for you going through this .................ray:

ray:ray:ray:ray:ray:ray:ray:ray:ray:"Hugs"

Maureen