Osteomyelitis help

[puffs-of-fluff]

Hi everyone, This is long but my bunny's life is hanging in the balance at the moment, so please take time to read and give me your experiences and advice.

Ethel has always had perfect health, but has been poorly over the last 6 weeks. Eventually, 3 weeks ago, a dental abscess finally popped up to explain it. It was in a bad place at the back of her jaw, so my vet ordered CT scans to check on it before operating.

The CT scan results have come back and shown extensive osteomyelitis (Abscess in the bone) in the lower left mandible BOTH lateral (side of the cheek) and medial (side of the tongue), as well as underneath the chin. The infection has also started to spread to the right side mandible, as that is also showing the beginning of infection. I have been told (by a specialist vet) that her abscess is inoperable, as there are too many structures involved, including infected tissue surrounding the carotid artery. There are 5 teeth involved at the moment (left molars 3, 4,5 and right molars 4, 5), but they are unsure if the infection started in these, or in the bone itself, as this extensive damage has popped up just 3 weeks after they looked in her mouth and everything was fine. I have been advised to have her pts, but refuse to give up just yet, as I feel we have tried nothing! She has so much more life left to live. She's not even 4. This isn't fair, she's too loved.

Her current health issues in the last few days is as follows:
1. Stopped eating by herself, but is eating soaked pellets offered to her in small amounts and is being syringe fed organic baby food smoothies. No longer is able to eat any hay (has not done so for about 10 days) and in the last 3 days has also stopped eating veggies (she was trying, but was unable to chew them).
2. Stopped drinking by herself, from a bottle or bowl (potentially because of the constant wet fur around her mouth annoying her), Is being force fed water from syringe, or will sip from a syringe herself when i mix some apple juice in the water,
3. Smells awful. Her breath and her fur around her mouth smell completely rotten. The vet thinks its her saliva and cannot see evidence of the abscess bursting.
4. Is snoring and whimpering when breathing. Mainly when relaxed or stressed. Seems quieter when neutral.
5. Has lost 300 grams since May (but has put on 70 grams in the last week thanks to my boyfriend and I syringe feeding like mad)

The vet has agreed to try antibiotics, but has told me that this won't cure her and will be a palliative treatment only. However, i am sure that i have read success stories on here of long term antibiotic success in keeping abscesses and osteomyelitis at bay. I really want to hear your experiences.

Her current medications are:
Depocillin - 0.25ml injection x1 daily
Metacam 12kg x2 daily
Tramadol - 0,18ml 1x daily
Rinitidine 0.5mg 3x daily
Metronidazol oral 0.9ml - 2x daily
probiotic with food

Please tell me anything you can to help, any advice you have about the smell of her breath and mouth fur, or any disagreements with dosage. Also, would love to hear some success stories (and when did you start to see an improvement)

Ethel and I thank you xxx

 

[puffs-of-fluff]

Update

She has eaten some dried pellets on her own and has even had a tiny bit of kale for the first time in over a week. I'm still giving her the soaked pellets as it's a good way of getting water in her. Still no chance of eating hay, I think its just too painful. I'm not sure if this means that the depocillin is working, or if it's because the vet upped her pain meds? Does anyone have any experience of how long the depocillin takes to make an improvement?

She is getting a bit more difficult to give meds to, struggling more and nibbling my clothes. I think this might be a good sign, as she is less listless. She usually behaves like this when restrained, so it was horrible to see her so docile and tired.

The snoring has got a lot worse, i can hear the fluid moving in her nose, sounds like she is full of cold. I'm not sure why she would even be snoring, the abscess is on the lower jaw. The vet said there was fluid in her nasal cavity on the CT, but said it wasn't an abscess. Can anyone explain why this would be? Is it just inflammation?

The abscess is much bigger than the last time i felt it a week ago (I try not to prod it because it's painful for her, and I'm prodding her enough with meds). It's obviously not been lanced, drained or removed because of the complications, but does anyone know if the depocillin is supposed to make this shrink, or will it just work to stop it getting bigger and reduce the infection in the bone and surrounding tissue?

My hope with the depocillin is that it controls and reduces the infection enough to improve her breathing, eating and drinking, and puts her in a better position to have the abscess lanced and drained, and the molar teeth removed. My vet says she hates the impregnated beads, as its another operation to remove them, else they swallow them (which is apparently dangerous?), and says there is little evidence they work anyway. However, i've seen quite a lot of support for them on here, so interested to know what you all think. I think my vet's point is that the osteomyelitis is too extensive, and they would only prevent an abscess popping back up in the area that she places them, so one would pop up elsewhere. She doesn't believe she will be able to remove all of the necrotic tissue from the bone anyway, and says that they can't do jaw replacements on rabbits (like they do in dogs and cats) due to their teeth. Again, any experience?

Please someone help

 

[RavenousDragon]

Osteomyelitis is VERY painful and unfortunately, as your vet stated, there is no jaw replacement in rabbits. Rabbit abscesses (even just in the skin) are (essentially) impossible to treat with just medication- rabbits have a cell called heterophils in place of what other mammals have called neutrophils and that means their abscesses are much thicker and more difficult to treat. Medication will only prolong your rabbit's life- it is very unlikely to cure anything.

Because your rabbit is young, it is likely she has some genetic teeth abnormalities which predisposed her to problems (stated another way- none of this is your fault and there was nothing you could do to prevent this).

Please keep us updated on how she is doing- we are sending good thoughts!

 

[doodlebugger]

I think the thing here to ask yourself is whether or not the bunny will have a good quality of life, and if you are just prolonging the inevitable. We have had chronically ill bunnies, and we have faced this choice many times......it's not easy because we love them and we want to give them every opportunity to survive. I would literally stay up all night, worried about them, and we would take them to frequent vet visits......and I can't tell you how much money we have spent to ensure we were doing our best for the bunnies. But the truth is that we have to look at the reason we are fighting so hard - is there really hope for a quality life? Is there really hope that they can survive the illness?
Have you looked at this website? http://www.medirabbit.com/EN/Dental_diseases/Treatment/Facial/abs_dental.htm
Another suggestion, depending on where you are at, is to consider calling a university with a veterinarian program to see if they have any one who would consider looking at your bunny and seeing if they can determine a better course of action.......I have heard some people who have a really serious or complication situation do this. At the very least, they get answers. Sending you good thoughts and hoping you can find a solution that will be the best for Ethel.

 

[puffs-of-fluff]

This thread didn't really take off the way I was hoping, which is a shame because I didn't find much real life experience of osteomyelitis when I was searching forums. I was hoping it would be a good thread for other people in this situation to read in the future, as I know it is a very stressful situation. Regardless, I thought i would give an update just for anyone searching in the future to read.

When i took Ethel to the vet, they were surprised at how well she had responded to the depocillin injections. My vet said that 2 things had happened, which kind of changed the game. Firstly, the anti-biotics had brought down the swelling in her jaw/gums, which is why she began eating better. Secondly, the lack of swelling in the gums meant that the abscess started growing outwards - and actually ended up splitting the cheek muscle. This sounds awful, but it meant that they could access it without the complications of the vessels and nerves in that muscle causing too much risk. So she went in for the operation on Thursday. She had 3 teeth on the left side removed, the bone debrided as much as possible, and the abscess lanced and drained. Apparently there was a small problem intubating her, as her throat was very swollen (they are unsure why), but they managed eventually.

She returned home the same day, as woke up well. She was very unhappy the first 2 days, barely eating (syringe fed day 1), but then brightened up and has been wonderful.

It's now tuesday. I have to flush the wound 2xday and pack it with manukha honey (ethel hates this process and i know it hurts her, but we manage just the 2 of us in a bunny burritto). She's still on depocillin daily, and will need for the wound to stay open 3 weeks. Then we will have a review. I am managing to keep the wound open really well so far, so I'm feeling hopeful. Still feeling burned out, but she needs me.

And I am pleased to report that she did her first binky in 2 months this evening.

I am very glad i persevered with this and didn't put my baby to sleep.

We may have a long way to go, but she is alive and well.

 

[PaGal]

I am so glad to hear the hopeful news! Thank you for sharing, I know you were hoping to hear from more people with experiences that would at least give you comfort if not hope and possibly a treatment plan or medicine that might work. You have helped others by posting, you have given anyone that may be in a similar situation hope that things can get better.

I am currently dealing with a tooth root abscess with one of my buns and it is hard. There is so little information or stories out there. You have to put your faith in a vet while continually questioning at least in your own mind whether they are doing the right things for your bun.

It is tiring with mixing food, syringe feeding/water. Giving meds. Repeated trips to the vets. The stress and worry.

Hang in there, know it or not you are not alone. I hope you will update a complete recovery in the near future

 

[Thumperina]

I am very relieved to read this great news! I felt real sad when I read your thread and I saw that very few people responded... and I am happy that your bun is doing so much better ! I hope she will fully recover, you are an excellent bunny owner. she is so lucky to have you! get well Ethel!

 

[msdiinsche]

Hello puffs-of-fluffs,
I was just researching this subject and came across your thread and wondering if Ethels' situation continued to improve?
My bunny has a mystery problem, I'm in New Zealand and don't have specialist vets here. He lost 500g in 6 weeks, he is eating, but not as much. He had some spurs filed back on his teeth, but continues to scratch his jaw like mad. The vet couldn't see any puss or inflammation. She took x-rays, but they don't mean much to her. She sent them somewhere else to get a second opinion and I am waiting on that.
Anyway, googling can drive yourself mad! I hope you had a good outcome with Ethel.

Best wishes

 

[cwebster]

Just found this thread and hope Ethel continues to improve. I had a guinea pig, Weasel, with a back molar that overgrew. Even though the vet trimmed it, he ended up with a massive infection that moved in behind his eye. I tried everything and was giving him morphine injections toward the end but his eye just started to disintegrate so i had to have him pts, sadly. I have had luck giving guinea pigs soyalac (soy infant formula)and Critical Care for Herbivores. Am going to pay extra attention to getting tooth checks for our bunny after reading how devastating rabbit tooth problems can be (our bunny had a suspicious area on a back tooth when we adopted her so will get a recheck). I so hope Ethel is lucky enough to overcome the osteomyelitis.

 

[Liung]

Lahi had a tooth root abscess from his upper left molar, causing a retrobulbar abscess. It wasn’t Osteomyelitis, or at least we never did definitive imaging to get a firm diagnosis. But when his eye began protruding, the vet said “something is pushing it out, it’s likely to be either a tumour or abscess and based on how quickly it grew I’m going to say abscess”.

After it was treated and gone, his backmost upper left molar became extremely loose and had to be removed, so we concluded that the root of the tooth pressing against his eye must have caused the abscess, and once the abscess was gone the tooth was no longer rooted in anything.

And we did treat it! We followed the treatment plan outlined in this study:
http://people.umass.edu/~jwmoore/bicillin/bicillin.htm

And in eight weeks he finished the treatment and was declared abscess free, no surgery required. His eye had noticeably receded back into his head just three days after the first injection, but we continued the full 8 weeks to be sure it was completely eradicated. That was in 2014, and he’s been abscess free since.

(Now he’s fighting with a malignant melanoma on his ear that is threatening to become metastatic but it’s unlikely that’s related.)




I don’t know if bicillin would be as effective for a jaw abscess as an eye abscess, but the study seemed to indicate it didn’t matter the location of the abscess. It does say that no digestive upset was ever noted, and Lahi did actually stop eating, but some probiotics cleared that up as long as I kept a very close eye on his eating.

Please give that study a read and I hope if you try it that it proves as much a miracle cure for your bun as it was for Lahi.

 

[cwebster]

Thank you for the post about how you treated Lahis tooth root abscess. Wish we had tried that wih Weasel guinea pig but like rabbits guinea pigs have to be treated very carefully due to penicillin toxicity. Am so glad Lahi recovered and hope he does well after the melanoma is removed. You both deserve happiness now.