Long-term hock abscess

[rabbit_friend]

tonyshuman wrote:

With zithro it seems to be more of a reduced appetite than mussy poo, if that helps. Sometimes buns on zithro have to be force-fed Critical Care.

Not sure about the other spot but sometimes long-term antibiotics can cause fungal infections to sprout up--like thrush or yeast infections in humans.

Thanks for the info. She's only had reduced appetite and lethargy on the tetra -- no mushy poo. But I was giving Bene-bac every other day throughout, so maybe that kept her stable (though the poos were oval and very light colored). She never quit eating entirely, but did quit eating pellets and also quit drinking for several days. So she lost weight, especially muscle. Luckily, she had some spare to lose, but she's now down to no extra.

I was thinking the hot spot looked like something fungal. The Vetericyn sprayed on in the last two days has already helped it a lot (with blow-drying till completely dry afterwards). She had scratched it raw with scabs, and those are all pink skin now. She even did a bliss roll two nights ago after I treated the spot and then fed her Bene-bac treat and her myristol/actiflex mix. Seems to be feeling a lot better off the abx, though the abscess does seem to be getting slightly bigger again.

I am looking into alternatives. Have you heard anything about olive leaf extract in bunnies with abscesses (or fungal infections)?

 

[tonyshuman]

Not familiar with that treatment. Most fungal treatments are topical, like miconazole, ketoconazole, or stuff like Vetericyn. Another option is to use a chlorhexidine or betadine cleaner daily. That won't work as fast as the -conazoles, but is less drugs in the system if that is a bother.

 

[rabbit_friend]

An update -- she's been off all abx for a little over two weeks now. She seemed to "crash" a bit about 4-5 days after discontinuing, so I think she's still suffering some from the gi effects. Her appetite and spirits are up and down -- last night she looked worse than when on abx, but some fluids perked her up. Continue to give bene-bac every other day.

I'm also still cleaning the abscess twice a day with Vetericyn and applying silver sulfadiazine. Although it is not open, cleaning it seems to keep it healthier looking -- when I've skipped a cleaning it has gotten a bit redder. It does seem to have enlarged slightly and I am concerned about infection spreading to the bone. Would xrays be the only way to tell if this is happening, or are there other warning signs?

The hot spot between her shoulder blades has responded well to Vetericyn. I tried putting on various creams after cleaning (HealX, Silver Sulfadiazine), and they all seemed to make it worse (maybe by trapping moisture on skin?). I went 24 hours yesterday without using the Vetericyn, just applying some aloe gel, and the crusty/flaky stuff started returning. So I think the Vetericyn is just inhibiting whatever it is, not killing it. Will try the miconazile, but is it safe to lick off?

Thanks for everyone's help on here. Pipp, I am hoping your story about your bun's abscess resolving on its own will end up being our story as well! I have been looking into boosting her immune system and have heard good things about beta glucans, so may try that.

 

[fuzz16]

hopefully things get better with time

 

[Maureen Las]

I believe that (at least with humans) a diagnosis of osteomyelitis would be based on a combination of previous history, physical exam, review of all previous blood tests and cultures and then an x-ray (which may not show osteomyeltis in the very beginning stages). ..Ultrasounds and Pet scans are better diagnostic tools.
I agree that this infection doesn't really sound resolved and would really be interested in how she would do on some of the other antibiotics mentioned above including chlorampenical and/or azithromycin .
I used Chloramphenical opthalmic solution on a bun who had an eye infection which would not resolve with any previous number of antibiotic salves/drops. It was my last attempt to save this bun and the chloramphenical improved the eye after the first instillation of the drops. ( almost seemed miraculous)
I used plastic gloves whenI gave the drug and it caused no issues with my rabbit other than improvement.
In terms of treating withanti fungal medsI would check with a vet first. you really do not know if this is fungal?

MRSA is zoonotic and contagious so it is really important to keep the environment
as sterile as possible.

 

[tonyshuman]

If you don't put too much of the miconazole cream on, it should be fine. I would not let her lick at it for a good 15 min after applying it though, and apply only enough to cover the area in a transparent layer. I think it would be a good idea since the other creams didn't seem to work--that's why I'm guessing fungal. The vet can tell you definitively what it is if you go, though.

 

[rabbit_friend]

Update: no abx since Thanksgiving, and everything was going along fairly well till this week. I've just been cleaning with Vetericyn and putting on silver sulfadiazine when the hock looked inflamed or getting larger again.

She gained back some weight, regained full appetite, was even binkying and running up and down stairs a few times. Mass around hock seemed much thinner two weeks ago and a scab had formed over the hole in the center. I was getting excited thinking it might be healing.

Then this week I noticed it enlarging again, and the scab looked more yellowish. Tuesday night there was pus oozing from it, and I soaked and got the scab off. Major thick white stuff underneath. Tried to pull some out with tweezers, and I caught hold of some stringy pieces and then some long translucent tubes like jellyfish arms. They seemed to be attached to blood vessels and looked like blood vessels, only almost transparent. I have never seen this jelly-like stuff before. Have been reading about mucoid degeneration and wondering if that's what this is?

Have been flushing twice a day for two days with Vetericyn and using the ssd and she seems to be feeling better (was favoring that foot for the first time in a long while).

Very disturbed at this new development, I scheduled an appt for yesterday with regular vet and for today with backup/2nd opinion vet, just to make sure I had some clue and a plan for the weekend. Regular vet told us when we showed up that he wouldn't look at her because he'd found out we were going to another vet. Oy veh.

 

[ra7751]

Just wondering....who is your vet? Had a minute so I thought I would pop in and check the forum. I talked with a very nice vet from TN aday or so agoregarding a long term hock abscess. Thought this might be the same case. Seems to be a lot of concern about the staph issue....staph isn't the major concern here. It is a "tag-along". Most skin infections in any species will grow staph. And there is probably yeast infections all over this rabbit due to the long term abx use. If the "root cause" is addressed, resolution of that issue will resolve these tag-alongs. The vet was very interested in our protocols. If this is your vet, she gave me the feeling that she is on her "A" game and I was very impressed with her. Thought we had a very interesting conversation. Regardless....hope your rabbit improves.

Randy

 

[rabbit_friend]

Yep--that was our first visit to our new vet after the other two who have been "handling" this for the past 15 months washed their hands of us. Glad to hear she impressed you.

Her first words were that we needed surgery, that you couldn't cure rabbit abscesses with just abx. I said I really would like her to call you, since you seemed to be able to do it, and we'd already tried the surgical route with disastrous results. She just asked me for the number and called right then and there, which definitely impressed me.

She said she uses bicillin and zithro, but that it has never resolved an abscess for her, so I'm curious how your protocol differs from hers.

She'll be willing to prescribe any of it -- zithro, chloramphenicol, bicillin, but how do we determine the "root cause"? I'll do a culture swab in the morning, but I remember your abscess posts saying that a culture wouldn't show several key players. The staph was methicillin-resistant schleiferi (gram-neg), by the way, not your garden-variety staph. But could be the tetracycline knocked that out and there's something else left, as you say.

Don't think she has yeast problems any more. No abx since November and daily olive leaf since then. The surgery in June tore the hock tissue up, leaving a hole and some cuts right on the weight-bearing part that have never healed. Have read since then that any surgery on a hock should be sure to preserve weight-bearing tissue - ha. Wish we'd run across your posts and gone to this new vet back then...

 

[rabbit_friend]

meant to update: very watery, runny pus coming out of the abscess opening yesterday. Not as much today, but she had a massive amount of mushy poo stuck to her butt (yuck). Seems to have cleared up tonight.

 

[rabbit_friend]

New culture results: no methicillin staph reported, but now we have enterobacter chloacae, a gram-neg rod which is resistant to chloramphenicol and doxycycline and susceptible to carbenicillin and neomycin (haven't been mailed the full report yet). New vet is thinking pen-G injections might take care of it. Any thoughts?

 

[rabbit_friend]

Went for practice session with bicillin injections yesterday -- we'll see how that goes. First one went without incident. She says to give daily injections of 0.7 ml for 7 days, then continue if needed. Earlier this week, she said 2 weeks past resolution, and I've read 8 weeks should be the minimum, so a bit contradictory.

 

[rabbit_friend]

So we've been doing bicillin (combipen-48) injections once daily for 8 weeks now. Abscess has gotten much smaller, especially in the last week or two. But after soaking the now small hole in the abscess to open it a bit, I keep getting some clear, very slimy fluid when pressing on the abscess. Any idea what this is and whether it represents some other type of bacteria present? I've read that strep can produce clear fluid in abscesses, but this doesn't seem like any pus I've ever seen.

She is tolerating the bicillin well. But the clear fluid seems to keep collecting. Also, the bare skin over the abscess has developed some brown spots in the last week or two. She has had these on her other hock as well and the vet just said they're pressure points. But one of the ones on the other hock has now turned more reddish, like a blood blister.

 

[rabbit_friend]

Talked to vet, who says the clear fluid might be serous fluid produced by muscles trying to heal. Don't know how many muscles there are around a hock bone, but hope she's right.

I also tried to get a new bag of LR from this vet since the bag from the old vet ran out, and the new vet said LR would be the last thing she'd use for a rabbit since it was high in sodium and could cause kidney stones. I had never heard of that, and have given LR in the past. I do know LR contains some calcium, so maybe she said sodium by mistake? Any comments?

 

[tonyshuman]

There's nothing wrong with lactated Ringer's solution for hydration of a bunny. Even if there is more calcium, which I'm not sure of off the top of my head, it wouldn't be enough to cause a problem.

 

[rabbit_friend]

That's what I was thinking. She gave me Normosol-R instead. Do you know if there's a preference (or contraindication) for one or the other in diluting bicillin injections? I've been following the advice on here and using the LR (and now the Normosol) to dilute the bicillin I'm giving.

 

[tonyshuman]

I don't think it matters which you use. They are both sterile saline solutions made to be injected.

 

[rabbit_friend]

Realized when looking up some of the newer health issues with my bunnies that I had never updated this thread. It took 10 months of bicillin injections, but the hock is healed now (though still bare). Gave probiotics, metacam and supportive fluids as needed. She tolerated the bicillin much, much better than the oral antibiotics. Did blood tests and follow-up xrays about 8 months into the bicillin and everything looked fine.

About a month before the end, when we weren't sure if the hock was fully healed, my vet suggested trying to taper off the bicillin by going to once every 3 days instead of every 2. The hock got worse again. But then I did the bicillin three days in a row before going back to every 2 days for 3 weeks, and that seemed to do the trick. I didn't taper - just quit - and just kept the healed hock clean and coated in udder balm when it looked dry so it wouldn't crack. Knock on wood, but the hock has been fine for the last 10 months and she has been a much happier bunny.

Now we just have to work on her spondylosis and arthritis

 

[fuzz16]

love udder butter..i am realy glad that this turned out for the best and hopeully he didnt turn into an angry bun because of all the meds

 

[rabbit_friend]

No, she is sweeter than ever, and she put up with a lot without much complaint during 2 years of treatments!