Leg Abscess - the healing process

[Rayen]

So I did get to see the vet that did the surgery today, despite being told she wasn't working today. Whatever, it worked in my favour in the end anyway.

She didn't want to remove the bandage today since she looked at the pictures and saw that it looked alright the last time we did a bandage change. We may have to get some of the excess tissue removed again, but she said she wasn't even going to think about it for a few more weeks.

I do kind of wish she had done a bandage change now that I did one afterwards. It doesn't look bad, but there was obviously more secretions than the last time I had done the change. The bandage was difficult to remove. It also had just a slight smell of infection. There wasn't any obvious puss and I'm going to start doing bandage changes every other day from now on to make sure things don't go badly. The wound still looks pretty healthy (to me at least) but there was a lot of tissue that fell off this time around while I was cleaning it. I don't know if I added too much honey and that caused some of the issues I saw or what, but now I'm a bit nervous and went with the anti-bacterial cream we were given.

 

[JBun]

The tissue that fell off would be dead tissue. It isn't from the honey but from the honey being diluted too much by weepage from tissue damage in the wound, which makes the wound too moist. You still want the honey, but it just means that bandage changes need to occur more frequently to prevent the moisture from damaging the tissue. I personally would keep using the honey. I agree that bandage changes need to be done more frequently, but wound cleaning and redressing really needs to be done twice daily, once daily at the very least. Keeping the abscess cleaned out is an essential part of the wound healing properly. And leaving dressing changes too long will just promote bacterial growth to continue, as will leaving dead tissue on the wound. It's important to keep the dead tissue cleaned away as it promotes bacterial growth as well.

If you haven't read through these links, I would suggest it. They explain why frequent bandage changes are important, as well as giving additional info on wound cleaning, applying honey and dressing the wound.
http://www.medirabbit.com/EN/Skin_diseases/Bacterial/Absc_treat/abscess_treat.htm
http://www.houserabbit.co.uk/resources/content/info-sheets/RWAF_Abscesses.pdf


You may also want to discuss with your vet, increasing the frequency of the penicillin injections. For abscess treatment the long acting penicillin is usually given every 2-3 days and the short acting penicillin is given daily, sometimes several times a day. Once weekly isn't frequent enough for the antibiotic to effectively fight the bacteria in the abscess. The daily baytril(enrofloxacin) may help some, but it usually isn't the most effective antibiotic against abscesses in rabbits. Antibiotic treatment for abscesses, really has to be quite aggressive to have the best chance of beating it.
http://people.umass.edu/~jwmoore/bicillin/bicillin.htm
http://www.medirabbit.com/Safe_medication/Antibiotics/Safe_antibiotics.htm

I think you are doing a fantastic job. Abscess treatment is no easy thing and requires a lot of time and care. Your bunny is lucky to have such a caring and dedicated owner.

 

[squidpop]

I just read through this whole thread and am so sorry for you and your bunny. I only have a few small bits of advice. One is that if he is not eating well you should also monitor water intake because if he might also be dehydrated and not drinking water will cause him to not want food. So if you suspect he is not drinking it would be good to syringe electrolytes, hydrate and then syringe food.

Also, since he is hard to syringe feed and medicate- my advice for that is: Try using a small syringe, even though it takes longer I use a 1 ml syringe usually because its small and I can get it in the opening behind the front teeth easily and they don't seem to fight it as much as my 5 ml syringe.
Another syringe I found that works well is a 3 ml monoject feeding syringe (people who hand rear baby parrots use them) they look like this http://fetchrx.com/monoject-monodose-oral-med-syringe-3-ml-w-cap. They have a longer tip which makes it easier than a regular syringe. I got a pack of 20 from ebay.

Also, I have a weird method of syringing meds that works for me and here is a picture of it - the rabbit can't go forward because I can hold his chest or head and can't go backwards because my body is in the way- so they usually give up and take their medicine.

 

[Rayen]

JBun, thank you for the links! The first one especially had some information that sounded like what happened with our bandage change, it'll definitely need to be changed more often.

I'll definitely ask the vet next time about daily bandage changes. She seemed to think that doing them too often would ultimately be too stressful and suggested every 3-4 days. Her initial suggestion was to do them daily, but that seemed to change pretty quickly. I'll be doing them every other day this week until Monday and I'll see how that goes. He's pretty good with it (basically just plays dead) but it does look like it hurts him. His leg really starts to shake after we clean it out.

Is there a good time after pain meds are given that I should be doing the bandage change? Would it be better to do it before pain meds and then give them when I'm finished? He doesn't act too uncomfortable after we're finished, but rabbits are so good at hiding pain!

Squidpop, thank you for the well-wishes! I've actually gotten pretty good with feeding and medication now, or he's gotten used to it, either-or. He'll take the syringe on his own now, so I don't have to force him too much. (He still spits up a lot of critical care all over me though!) The vet always makes sure to look him over and so far he hasn't been dehydrated. He eats a lot of vegetables, since that's about all I can get him to reliably eat on his own. He even gained a tiny bit of weight this week! From 1.64kg to 1.68kg.

 

[JBun]

I don't recall if you said, which pain med is your rabbit on, what's the strength of it(mg per ml), what dosage are you giving, and how often?

How does he act after the bandage change? Is he resuming normal activities or does he go and hide somewhere for a while? The problem with putting off a bandage change for 3-4 days is that it doesn't promote a healthy environment for the wound healing. Think of it like when we have a cut. Leaving the same bandage on for that long wouldn't be good and would likely lead to the infection worsening.

Are you also cleaning out the wound, pus, and dead tissue when you do the bandage change?

 

[Rayen]

The box says M-Eloxyn, 1.5mg/ml. The bottle also says it's meloxicam? He gets 0.5ml twice a day right now.

His actual wound is pretty open, I'm not really sure how to describe how it looks (I could post a picture? but it's pretty gross). It's not like a pocket that I have to clean out with puss. Every time I've cleaned it, it didn't have any noticeable puss on it. When I clean it, I just use normal water and a syringe that they gave me. I use a bit less than a litre of water and I just sort of gently spray off the dead tissue and anything that was stuck to the wound.

After bandage changes he acts pretty much normal. He'll try to 'clean' the bandage for about an hour afterwards then for the most part will just leave it alone. He does get a bit irritated with me, and won't let me pick him up as easily for feedings/medication afterwards but that's about it.

 

[JBun]

The meloxicam twice a day should be providing him constant pain relief coverage, so won't matter when you do the bandage change. If your rabbit is around 2kg/4-5lbs, then he's getting the right dosage.

If you feel it is hurting him still too much and he acts in pain afterwards, you can get opiate pain meds from the vet that you can give a half hour prior to the bandage change to help control the pain, but it may also have some sedating effects. To me though, it sounds like it isn't bothering him too much if he sits and grooms afterwards.

Sounds like you are getting the wound cleaned out. That's great that you aren't finding pus in there. That means the antibiotics are working and the wound is healing. Hopefully the more frequent bandage changes will help as well.

 

[Rayen]

I did another change. I think I will do at the very least one bandage change every other day from now on. It just looks so much better (in my opinion, anyway) than what it looks like after three days. The wound is a lot more pink, it's not nearly as bleedy and the infection smell from last time is gone.

I'm back to using honey too. We'll see how the next one goes!

 

[Rayen]

Yet another bandage change!

I'm not sure if this is good or bad, but a large chunk of tissue fell off today. It's very unnerving. It wasn't bloody and the actual wound still looks pretty good and doesn't have that infection stink, so I'm hoping it was just an unusually large piece of dead tissue?

That peeling piece is also still really peely. I'm probably going to push for the vet to rebandage it and take a look herself rather than just my pictures this week.

He started eating some pellets the last few days! Not frequently enough for me to avoid critical care feedings, of course, but oh well. It's something.

 

[Rayen]

We saw the vet and we agreed to just do the change every other day for now. The person helping me is already starting to get a little fed up with assisting on the bandage changes every other day as it is, and I'm seeing improvement with the two days so I'm just not going to press the issue for now.

We've scheduled the tissue removal for next week. The vet doesn't see any cause for concern right now with the wound, she said it looks like it's healing about as well as she expected.

His weight stayed about the same this week, not super great news because I was hoping for a bit more improvement. At least he didn't lose anymore, I guess. His lady friend is starting to look a little plump too, I'm going to need to get more creative on how I feed him to stop her from inhaling everything.

 

[Rayen]

I'm still not super great at wrapping his leg, thankfully everything seems to stay in place when I go to change it so I guess it isn't a huge problem. This time's bandage probably looks like the worst one I've done this far. Poor little guy!

The wound itself is still about the same, though I did notice a few spots looked a bit darker red. I hope the skin around it isn't starting to die again, but it doesn't look bad enough to really start panicking yet. It didn't smell bad and the rest of the wound is still that bright pink colour so I'm hoping I'm just seeing things. I'm not sure if it's because so much tissue has fallen off this last week, but the wound doesn't look nearly as bulky as it did. I hope that's good news.

I ran out of tape that the vet supplied me with and I figured, no problem, I'll just go pick some up from the store. The stuff they gave me felt like maybe cloth tape (clearly I need to ask more questions!), so that's what I picked up. I don't know if it was the brand or what, but this stuff isn't very sticky and it doesn't feel the same as the stuff I had and it doesn't stay on at all. Ugh. I bought a different brand today, so I'll try it until I get back to the vet on Monday.

I'm really excited for when it really starts to look like there's been some big progress! Bandage changes and daily medication and forced feedings are no fun for anyone.

 

[Watermelons]

Rayen you're more then welcome to post photos of the wound here.
Not only would it be a great educational tool to see the healing process, but those who are trying to help you here, can handle looking at that stuff so there's no worry

 

[stevesmum]

You're doing an awesome job, not everyone would have the patience or the willingness to spend so much time or money on their pet. Kudos.

 

[Rayen]

I haven't weighed Quinn since the last vet visit, but he definitely feels like he's put on a little bit of weight these last few days. He just feels heavier. I hope that translates to getting him back closer to his original weight!

The bandage change went about as it usually does. I really can't see any progress myself, but the wound still doesn't look like it's getting worse so I guess that's a positive right there. I'm still terrible at wrapping it, and each time I go in I think that today's going to be the day I do it right (I'm always wrong).

On the bright side, the second tape I bought apparently is the right stuff! It stayed on really well. But I ran out of the non-stick pads they gave me so I had to buy some of those too. The bandage is only staying on this one day so if these are the wrong ones at least it won't be staying on too long.

 

[JBun]

I don't know that bandage changes ever go on a pet's leg very well, due to the difficulty of wrapping legs period. Legs are just awkward to wrap. I have a rabbit who's leg i had to wrap for several weeks, and it never seemed to end up exactly how I wanted it, or stay on as well as I would have liked. You are dealing with the difficulty of wrapping a moving appendage, not to mention a rabbit that doesn't necessarily hold still while your wrapping.

It is good the wound isn't looking any worse. I would think that it should gradually be looking a little better. Maybe ask your vet about it. The weight gain is really good though. Means your bun is feeling better anyways, and the wound isn't too troublesome.

Glad things are going better now.

 

[Rayen]

So the vet cleaned his leg up again. I'm not sure what to think anymore. I'm so tired of this whole thing and I really want it to be over and healed.

Basically she said that she had hoped that there would have been more progress by now. That there was some dying tissue around the wound, and that she was concerned about how far we had come in six weeks. She gave me a new medication for the next couple of weeks (it says sulfatrim suspension 1ml every 12 hours) and that in roughly two weeks if there hasn't been any positive progress we'd have to look at our options again.

She mentioned amputating the leg, which I am not going to do. He isn't getting around super well on the three legs right now, he's able to walk alright and all but he has trouble supporting himself at times and can't clean his face as well as he'd like to. Plus it's another big surgery and I don't think I want to put him through it after two months of trying to get this thing to heal.

On the plus side, I suppose, she said that once she got all of the excess tissue removed that it didn't look bad. She was a bit concerned with the smell of it, but I always assumed that it was the smell of using honey. It never really smelled infected to me, just this weird kind of sweet smell. I don't know. Maybe it was just a different kind of infection smell? Ugh.

I just wish we hadn't left the bandage on for that full week early on. I can't help but think that it would've been healed or at least close to it if we had done more bandage changes more often early on. I relied on the vet's advice and I think she was too earnest to try and make it easy on me and the person helping me change the bandage.

 

[Rayen]

Sometimes family can be extremely annoying. My mother can't help herself but mention every single time I see her about how I should've just put him to sleep. That he's not going to get any better and that I've just wasted all of my time. I've asked her several times to stop, but apparently that's too much to ask for.

I cleaned his leg today and, I don't know. I didn't see it before they wrapped it up on Monday so I can't say if it actually looks any better. It certainly looks better from when I last saw it, all of the extra crumbly bits are all gone and it's a lot smaller and cleaner looking. There appears to be some new white tissue on it that didn't easily peel off when I cleaned it, I don't know if that's a good sign or not.

I've just got to think healing thoughts for the next couple of weeks! And avoid my mother, I guess.

 

[Akzholedent]

Rayen, you're doing the best you can for him. I'm sure if he looked like he was absolutely miserable with no chance of making it, you'd have made that decision, but you decided to give him his best shot. I know it's been a very long process, and I'm sure it's not cheap.. but waking up every day to see his cute furry face must be worth it. <3 Some people really don't "get" it... and that's their loss.

 

[pani]

I've just read through this whole thread - I'm so sorry about what you've been going through! It can be tough when everyone seems to be against you - the vet's unhelpfulness, your mother's 'suggestions', and even Quinn's unhappiness with being held - but you're doing so well! Felix, Clem, and I are sending good thoughts and healing vibes to you guys. ray:

 

[Rayen]

Okay, I'm just going to post a couple of pictures of his wound today. I guess at this point where I'm looking at possibly putting him to sleep, I'm just searching for some kind of good news. There does seem to be a little bit of wonky tissue growth on it, which I'm not super happy with (on the pictures, it's that weird white bubble towards the top), but the rest of the wound looks pretty good to me. I really want this thing to heal. I've convinced my helper to clean it out tomorrow as well, so maybe I can get some daily bandage changes in for a bit.