Emergency???

I have a male white rabbit, 5 years old.

He often has eye discharge (not now, but always has it) and bad breath.

He stopped eating about 5 days ago.
Now he's drooling excessively, breath smelled like acetone (got a little better after we started feeding him bunny food juice with a syringe), almost don't poop at all, perhaps for not eating solids anymore. he tries to give a bite in his food and stops there. Eating seems to hurt him and he refuses even the liquid food given with the syringe.

He has some sort of nodule under his chin. It's painful,he doesn't want anyone touching it (I found it out while cleaning his drool). The vet said that wouldn't cause the drooling, etc., but didn't examine it to know what it can be.
His feces were examined and at least the thing the vet suspected it could be is ruled out. Lots of gas trapped in the intestine but he's being medicated for it.

I took him to all available vets in my town but nobody found any cause for his case, they're as puzzled as me and are welcoming help. They sent us home and told me to keep trying to feed the bunny.

I know my bunny wouldn't be acting like this from out of the blue without a reason, and that his symptoms seem classic for teeth problems. I'm posting the 2 x-ray pics here, perhaps someone will see something and help us?

THANKS, ANY HELP IS WELCOME!!

for the x-ray pics, go to:
<a href="http://s175.photobucket.com/albums/w146/hotmaildeal/?action=view&current=MILU-1.jpg" target="_blank"><img src="http://i175.photobucket.com/albums/w146/hotmaildeal/MILU-1.jpg" border="0" alt="MILU"></a>

and to:
<a href="http://s175.photobucket.com/albums/w146/hotmaildeal/?action=view&current=MILU2.jpg" target="_blank"><img src="http://i175.photobucket.com/albums/w146/hotmaildeal/MILU2.jpg" border="0" alt="Photobucket"></a>

I'm sorry I don't have any advice to give you re your bunny but I'm sure someone will come along soon to help, unfortunately it's 3am in the UK & most members will be asleep now

I'm glad you've been taking your bunny to see your vet & trying to get help for him, that's always a good step.

Do you mind my asking where you're from & if your vets are used to treating rabbits? Some are more experienced than others.
Also, I believe it is possible to be referred to a specialist depending on what the potential diagnosis is, but that would depend on where you are too.. I presume you're not in the UK?

To my limited knowledge it does sound like your bunny has dental problems from the symptoms you've described but I'm sure someone more experienced will be able to offer some suggestions.

I really hope your bunny will be ok & Im sending lots of vibes for your bunny.

I agree, it definitely sounds like a dental issue.

I'm not really up on interpreting xrays but the bottom set of teeth roots look to extend very close to the bottom of the jaw. Dental issues in rabbits can cause the roots to overgrow and abscesses can form along the edge of the jaw bone.

Have the vets looked in his moth with a scope (like looking in the ears)? What to the teeth look like? It's common for spurs (pointy bits) to form on the edge of teeth and these poke into the tongue or gums and cause sores and pain when eating.

There's some pictures of that here: http://www.vet.uga.edu/mis/exotics/mammals/oral.php second picture down shows spurs.

If there is a bad smell in his mouth he either has an abscess or infected sore that's creating the smell so I'd have thought the vet should be able to see something looking in his mouth.

I think you need a rabbit expert. Have you got any rabbit rescues near you or a branch of the house rabbit society? They might be able to recommend the closest vet with rabbit knowledge.

In the interim painkillers, antibiotics (by injection) and a gut stimulant may help start him eating again and feel more comfortable. It is really important you keep food going in without you get to the bottom of the problem. It's definitely quite a serious problem

Thanks everybody!
I'm in Sao Paulo Brazil, there aren't many vets who treat bunnies here.. basically I went to what's supposed to be "the best" and I guess anyone else figured the problem better. They didn't look at his mouth with the scope - I wonder if they KNOW how to do it!!!!! I mean, it's pretty obvious it's a mouth/throat issue, they suspected it too, but didn't take a look except for the x-ray. I don't know what to do. I'll try to ask them once more to take a good look there. Thanks and any other opinion is welcome

BTW - I posted this on another website too, and someone said "Your rabbit has a mandibular abscess secondary to a molar root impaction.* Most vets do not know how to properly*treat this condition." - does anyone else see a molar root impaction too?

THANKS A LOT! *

I cant access the photos but you description does sound like a Dental problem- tooth root elongation and possible abscessation

http://books.google.co.uk/books?id=...v=onepage&q=rabbit tooth root abscess&f=false

You definately need to try to locate a Vet with some experience in the treatment of Rabbit Dental Disease.

TREATMENT OF DENTAL DISEASE (INCLUDING ABSCESSES) IN RABBITS
Frances Harcourt-Brown BVSc MRCVS
Harrogate, UK

Treatment of Malocclusion:

Although skull radiology is useful for any case of dental disease, it is not mandatory for rabbits with malocclusion.
Crown abnormalities can be seen by visual examination. Treatment of malocclusion depends on the teeth that are
involved, the underlying cause and the stage of dental disease. Whichever method is used, it is impossible to
restore normal shape and position to the teeth.

Treatment options include:
· Trimming with handheld clippers. This is often inadvisable e.g in cases of congenital malocclusion, or in
the early stages of the progressive syndrome of dental disease (PSADD) when the teeth are still covered
in enamel. These teeth will shatter if clipped, leaving sharp edges and may expose the pulp cavity. In the
later stages of PSADD, when the teeth are weak, permanently deformed and have with little or no enamel,
the careful use of clippers is acceptable. Clippers can also be used for removing spurs from cheek teeth
without removing the whole crown.
· Burring teeth. This procedure does not shatter teeth and gives greater control over the final shape. But
there is a risk of iatrogenic injury to surrounding soft tissues. Although it is acceptable to burr individual
teeth down to the gum, the practice of 'generalised coronal reduction' i.e removing the crowns of all the
cheek teeth is unnecessary and potentially harmful. It may expose innervated dentine and pulp cavity. It
impairs the rabbits ability to eat fibrous food post-operatively.
· Tooth removal. Incisor removal is the treatment of choice for incisor malocclusion. Removal of cheek teeth
is more difficult. It is easy to pull loose, broken crowns off diseased cheek teeth in the later stages of
PSADD. Extraction of the entire tooth is more difficult. A common indication is in treatment of abscesses
when the tooth may be removed through the mouth or through the abscess cavity. Extraction of opposing
cheek teeth is unnecessary because the molars do not occlude exactly with each other. If elongation does
occur, opposing teeth can be periodically shortened.
Useful instruments for dental treatment include gags and pouch dilators, long handled molar clippers, diamond
rasps, diamond cutting discs, a range of burs, elevators, large bore hypodermic needles, special extraction
forceps and adapted needle holders to grasp tooth roots in abscess cavities. A Volkmanns scoop is essential for
the treatment of abscesses.

Treatment of abscesses:
Abscesses in rabbits are notoriously difficult to cure. They tend to be slow growing and relatively painless with a
thick fibrous capsule. Resorption of water from pus results in thick, caseous material within the abscess cavity.
Antibiotics cannot penetrate abscess cavities because of the poor vascularity. Lancing and flushing is seldom
curative and recurrence is common. There may be fibrous tracks into deeper tissue and the thick wall of the
abscess capsule is so rigid that it does not collapse after surgery. Residual microorganisms lead to renewal of
inflammation.
The key to successful treatment of abscesses is accurate diagnosis and elimination of the inciting cause along
with removal of necrotic tissue and effective local antibiotic therapy. Causes of facial abscesses include:
· Periapical abscesses associated with the syndrome of acquired dental disease.
· Puncture wounds: Fight wounds, elongated crowns puncturing buccal mucosa or lips.
· Foreign body reactions: e.g. Pieces of hay or splinters wedged in alveolus or nasal cavities.
· Iatrogenic: e.g after incisor removal, tooth trimming, penetrating injuries from dental burrs.
· Otitis
The list of differential diagnoses (neoplasia, cysts etc.) is same as other species. Palpation and a thorough oral examination to examine the shape and position of the crowns are essential. Skull radiography gives valuable
information about the roots of the teeth. Haematology is seldom helpful. Rabbits with abscesses seldom show a leucocytosis and neutrophilia although a left shift may be seen. Instead non specific signs of ill health such as mild
anaemia and lymphopaenia are seen.
Culture and sensitivity identifies the bacteria that are present and aids antibiotic selection. A variety of aerobic and anaerobic organisms may be cultured including Pasteurella multocida, Staphylococcus aureus, Fusobactereum nucleatum, Pseudomonas or Proteus spp .

Treatment options:
Do nothing: Not the treatment of choice, but not all owners consent to extensive treatment. Once an abscess has been opened it is unlikely to heal and will leave a draining fistula so it is sometimes better to leave it alone with the capsule intact. Many rabbits with abscesses eat well and appear to enjoy life. Permanent antibiotic or analgesic therapy can be beneficial. Very occasionally, abscesses will resolve on their own.

Antibiotic therapy: The choice of antibiotics in rabbits is not a straightforward as in other species. Oral
antibiotics can upset the balance of micro-organisms in the caecum and lead to overgrowth of pathogenic species
such as Clostridia spp. and the development of enterotoxaemia. Antibiotics that are indicated for osteomyelitis in
other species, notably clindamycin or lincomycin are likely to interfere with the gut flora in rabbits. Penicillin,
cephalexin and amoxycillin are less likely to interfere with caecal microflora but must be given parenterally not
orally. In general, safe oral antibiotics, such as enrofloxacin, are not effective for treatment of purulent infections.
Potentiated sulphonamides inactivated by exudate and debris.
Surgical removal (plus systemic antibiotic therapy): This is the treatment of choice subcutaneous a for
abscesses that are not attached to underlying structure. It is impossible to completely remove periapical
abscesses.

Surgical drainage and topical therapy
Surgical drainage, combined with topical antibacterial therapy, systemic antibiotics and removal of all pus and
necrotic tissue is curative but not always feasible. Marsupialisation of the wound allows cleaning of the wound
and application of topical treatments. It is important to remember that topical preparations can cause
enterotoxaemia. Abscess cavities can open into the mouth or rabbits can ingest topical preparations during
grooming. Gentamicin is a safe antibiotic if it is ingested.
Honey is an effective topical remedy. It promotes the formation of clean, healthy granulation tissue, acidifies the
wound and stimulates healing. It hygroscopic effect draws infection from surrounding tissue. Honey has natural
antibacterial properties that are effective against a range of bacteria.
Antibiotic impregnated polymethyl methacrylate (PMMA) beads are alternative way of providing topical
antibacterial therapy. They deliver high local concentrations of antibiotic for long periods of time. Gentamicin
impregnated beads are effective for approximately 1 month in infected wounds. Doxycyline gel can be used
instead of beads. An advantage of these methods is that the skin over the abscess cavity is stitched so the rabbit
can go home without requiring further treatment from the owner. The disadvantage of beads is that they can act
as foreign bodies after the antibiotic has gone. These preparations are only effective if all the necrotic tissue is
removed.

MANAGEMENT OF RABBITS WITH DENTAL PROBLEMS
Fibre is an important part of the pet rabbit's diet. It promotes gut motility but rabbits with dental problems often
struggle to eat hard food so an alternative to hay is often necessary. Fresh grass, vegetables and plants are
softer, although they may need to be shredded or chopped. Pelleted or extruded foods are preferable to cereal
mixes. They can be softened so rabbits with severe dental changes can eat them. Vitamin and mineral
supplements are only necessary for rabbits that only eat selected foods, such as peas, maize, apples or carrots.
The calcium requirement for rabbits with teeth that are no longer growing is substantially reduced. Rabbits should
be allowed daily exercise if possible. They benefit from the opportunity to bask in the sun during the summer. This
not only allows them to synthesise vitamin D but enriches their lives and allows access to grass and other plants
that will provide them with a varied diet and additional dietary fibre. Grass (and hay) contain optimal calcium and
phosphorus levels for rabbits.

Jane- try http://s175.photobucket.com/albums/w146/hotmaildeal

There are darker areas around the apices of the mandibular molars, particularly M2 and M3 but also of M1 and PM2 (sorry, I'm unable to tell which side as there is no label on the Xrays) showing that bone has been lost/broken down. I would be strongly suspicious of an infection there which would explain the discomfort and smell.
His occlusal surface is uneven at the back of his mouth likely due to irregular growth due to inflammation at the base of the lower teeth. There is mild 'root' overgrowth of the other mandibular, and the maxillary cheek teeth.
Where you have circled I don't feel is a broken tooth, but as the Xray is an oblique (not 100% straight across his skull) this appears to be the opposing molar showing up.
Where the lump is there is a brighter line that may be inflammation and so more dense tissue but is is not possible to say whether this lump is the start of an abscess/a breakthrough of infection elsewhere or something else. It doesn't appear to have affected the bone.
The abdominal and thoracic Xrays show no food throughout the GI tract and a gas-filled caecum. I would try and get as much food as possible into your rabbit rapidly as when the intestines are this empty they can be very difficult to get eating and moving food through. As the gas extends right through the gut and no food/liquid has been trapped an obstruction is unlikely but if he starts to develop bloat get him back to your vet imediately. The acetone smell you mentioned is release of ketones - when the body starts to break down tissue proteins and fats in response to prolonged lack of energy. There is also spondylosis of the sacral vertebrae but this is unlikely to be significant currently
At the moment food and pain relief are the over-riding critical requirements. Antibiotics would also be sensible (ideally injected as they will not be well absorbed from the intestines and could disrupt the intestinal function further) to start addressing the infection. Once he is more stable then you have option to continue antibiotics and repeat Xrays after a long course or go for extraction of the affected teeth.

marie_kubiak said:

Jane- try http://s175.photobucket.com/albums/w146/hotmaildeal

.

Click to expand...

Thank you

Thanks for all the input.

Tamsin: I figured they didn't look at my bunny's mouth with a scope 'cause it was out of battery. They tried today, with the low battery and found it hard to see, but found teeth "a little longer than should be" but "don't seem to be yet big enough to be a prob"

Marie_Kubiak: Thanks for interpreting the x-rays so meticulously!! Do you see an impaction there too?

Jack's-Jane: Thanks for all the info!

to all:
Today my vet gave my bunny metoclopramide chlorhydrate. At least he ate ground leaves (the bunny, not the vet, hehe) - first solid stuff in his tummy after 6 days!!

Also took a look at his mouth with a scope. Er.. embarrassing as it sounds, the batteries were almost fully discharged so he couldn't see well. The teeth are a little bigger than should be, but the vet thinks this is not yet a problem, according to what he COULD see.

I was said that my bunny has "molar spurs" (seen on x-ray) and "impaction in the rad, that usually leads to an abscess, which is what I have on my hands". He suggests a combination of (injectable) Penicillin g/Zithromax to control the abscess infection and said metoclopramide is risky. Anyone has any input about the medicine suggested, please?

* Rio: funny as it is, my bunny prefers to eat wood to mashed apple or leave juice from the syringe! I can't understand what's going on.. today, with the metoclopramide, he ate "real" food (carrots and ground leaves) not forcedly.

* Bunny girl: tks for the pics!

Thanks a lot! (I'd have replied before, but had connection problems, sorry)

hotmaildeal said:

Thanks for all the input.

Tamsin: I figured they didn't look at my bunny's mouth with a scope 'cause it was out of battery. They tried today, with the low battery and found it hard to see, but found teeth "a little longer than should be" but "don't seem to be yet big enough to be a prob"

Marie_Kubiak: Thanks for interpreting the x-rays so meticulously!! Do you see an impaction there too?

Jack's-Jane: Thanks for all the info!

to all:
Today my vet gave my bunny metoclopramide chlorhydrate. At least he ate ground leaves (the bunny, not the vet, hehe) - first solid stuff in his tummy after 6 days!!

Also took a look at his mouth with a scope. Er.. embarrassing as it sounds, the batteries were almost fully discharged so he couldn't see well. The teeth are a little bigger than should be, but the vet thinks this is not yet a problem, according to what he COULD see.

I was said that my bunny has "molar spurs" (seen on x-ray) and "impaction in the rad, that usually leads to an abscess, which is what I have on my hands". He suggests a combination of (injectable) Penicillin g/Zithromax to control the abscess infection and said metoclopramide is risky. Anyone has any input about the medicine suggested, please?

* Rio: funny as it is, my bunny prefers to eat wood to mashed apple or leave juice from the syringe! I can't understand what's going on.. today, with the metoclopramide, he ate "real" food (carrots and ground leaves) not forcedly.

* Bunny girl: tks for the pics!

Thanks a lot! (I'd have replied before, but had connection problems, sorry)

Click to expand...

I suspect the Vet may have said that it's the Penicillin that is 'risky' rather than the Metoclopromide.

http://www.rabbitwelfare.co.uk/resources/content/info-sheets/penicillin.htm

I have numerous Rabbits whom have been on Penicillin INJECTIONS with no adverse reaction. Penicillin should NEVER be given orally to a Rabbit.

Metoclopromide is a gut motility stimulant active on the upper GI tract and is used as a standard part of the treatment of Rabbits with GI hypomotility as long as there is no possibility of an actual obstruction within the GI tract.

The fact that your Bun appeared to prefer to eat wood rather than mashed apple etc is because he will be craving FIBRE which is an essential part of a Rabbit's diet to insure the hind gut functions correctly.

What pain relief is your Rabbit on ? Pain control is absolutely ESSENTIAL and the Dental problems your Rabbit has will cause him pain. A Rabbit in pain is unlikely to eat much and this in turn will cause the GI tract to close down leading to even more serious problems.

Ideally it would be a good idea for a Vet to carry out a full 'Dental' under GA to burr the molars down to gum level and remove any spurs . With elongated tooth roots keeping the crowns of the teeth short can help reduce the rate of progression of root elongation. It can also help minimise the chronic pain.
But of course the teeth are continuously growing and in Rabbits with established Dental Disease regular 'Dentals' under GA are usually required.

http://www.vetdent.eu/downloads/dent-rab-tooth-elong.pdf


I guess the above options may not be possible for your Bun though, given where you are :?

So I would say that good pain relief plus the injectible Penicillin might be as much as the Vet can offer :?

Supportive feeds are likely to be necessary. A liquid feed with a good fibre content is best to give and I dont know if you could obtain some of this

http://www.oxbowanimalhealth.com/vets/products/critical_care

Good luck and please keep us updated if you can !!

Thanks, your explanation was very clear and precise.
You're right, I can't find anyone who seems able to do dental work on my lil bunny. And not even to give him pain medicine. They say it would stop gut motility and food would ferment in my bunny's stomach. But if he's in pain, he won't eat. Sigh....
The bad thing is my bunny is getting fed up with the forced feeding and doesn't want it anymore. The amount of gas in his belly is another thing disturbing him immensely, and that simeticone doesn't seem to help at all. I hear his little belly "roaring" from far and can only imagine his pain - every single day, esp. after I feed him.
Also, I noticed he sometimes wants to eat paper. Should I let him do it, under the assumption that it's "better than nothing"?

I wouldnt let him eat paper, no, it could cause a blockage and I think the poor rabbit has enough problems already

If he's willing to eat, then try whatever 'proper' food he'll eat - fresh grass, chopped up vegetables, herbs, pellets (softened with water).

Thanks! I never let him eat paper, but now he absolutely refuses ANY sort of food - except for paper!! I don't know what to do anymore.... can't find a vet here to treat his teeth, can't feed the bunny properly, can't get rid of the gas in his tummy...
still keep on trying!

I'm back home with my bunny, ALIVE, after having had a dental procedure.
The pet dentists gave me pics of my bunny's mouth, he had 4 teeth that were not ok - 2 spurs and 2 elongated. NO extraction done -I wouldn't let it be done anyway, even if they wanted.

I was told about an antibiotic combo to treat the abscesses, but I'll have to look for someone else for administering them... for now I'm glad my bunny already jumped around and ate..

Thanks all your support and help!

ive only just seen this ... well done for persevering ... im pleased your bun is home and eating ..

hope hes ok now :wave:

He's no yet 100% but well, he's better. I worry 'cause he's almost not producing any droppings at all. It's been more than 24 hs and nothing. Last time it was 3 little "stuff" only, 1 was a cluster of tiny things and 2 were completely watery. That was the only time he produced something since Thursday..

Here goes the image my bunny's dentist gave us. Above, you see before and below the same area after the dental procedure.

Ouch! Those are some pretty nasty spikes.
I hope he is all better very soon. Some probiotics such as fibreplex may help get things moving again xx

Awwww por bun, they look very painful.
I'm soo glad you've been able to find a vet to treat him.. at least now his pain will be much relieved & he has a fighting chance

Will your bunny not eat hay instead of paper? Sorry I have no idea what rabbit foods are accessible in Brazil

Do you have apple puree there? maybe a small amount of that in a bowl? .

Could you blend or puree the food/vegetables he normally eats (mix with a little water if too thick)and put it in a shallow bowl to make it easier for him to eat?
sue

I see he ate something a couple of days ago-hope he's eating again now?

Oh gosh what an ordeal you and your bun have been through.I am so glad to read that he has now had a dental and is improving a little. It is great that he has eaten, I hope his gut starts to move more soon.

Keeping my fingers crossed for you.

hi again everybody

About the foods, my bunny is picky and he doesn't always eat hay or the things I give him...
The good thing is: he's back to normal!!!
he did his "job" today (LOL) and it seems like his GI is ok again. He eats normal food (Thank God!), plays, goes potty.. he's a normal bunny now.

THANKS for your care, support and help!
BTW you all have cute beautiful bunnies! I love to see their pics..

My bunny was very ill and I can tell you all not to give up when facing difficulties, sometimes it seems like there's no way out.. but he didn't give up neither did I, and now he's good

I wish you all the very best, thanks for all!!