Rabbit worries - thymoma - help / advice greatly appreciated

Hey all,

Last October / November, my lovely 7-ish year-old, three-legged, dwarf-lop house rabbit Biscuit started to get bulging eyes. I took him to the vet, and was told it was likely stress. This made sense, as my girlfriend had just moved in and there were all sorts of boxes laying around - but it get worse and worse. The vet started treating the symptoms with various things, first some steroid eye drops (which made things much worse), and then various courses of antibiotics. The antibiotics seemed to help a little, but as soon as the course finished the symptoms came back.


Biscuit (left) in happier times!

One evening in February, with the eye symptoms still persisting, Biscuit suddenly started gasping, open-mouthed, for breath when he was held tummy-up. Since this was totally out of character and quite frightening to see, I took him straight to a local emergency vet. They examined him and said he appeared to be in general good health, but that the combination of swollen eyes and breathing issues could be a symptom of something more serious. They prescribed some more antibiotics and booked Biscuit in for chest and head x-rays.

On the day of the x-rays I received a call to say that Biscuit had something bad in his chest. The vet drew some fluid from Biscuit's chest cavity and said that it was bloody which indicated a strong possibility of thymoma. They asked if I wanted them to do an ultrasound in an attempt to confirm this, and the results (though still not definitive) were as expected. They said that the suspected thymoma was squashing Biscuit's lungs into a corner of his chest (causing the breathing difficulties) and likely restricting blood vessels to the head (causing the bulging eyes). They suggested he be put to sleep within 24 hours to avoid suffering.

I was too upset to go ahead with this straight away (as in general he seemed ok) - and once he got over the sedation he was given for the x-rays, he seemed better than ever. His eyes were back to normal, his breathing was good, and he was more energetic and mischievous than he'd been in literally years. The vet was really surprised and delighted with Biscuit's turn-around. He said the removal of fluid from Biscuit's chest (something like 6mm) had probably reduced the pressure and so the symptoms - but told us we needed to prepare ourselves, as it would only be a matter of months / weeks / days before the fluid returned or the tumour grew.

A week and a half on, Biscuit's eyes are bulging again, and his breathing has become a little more ragged than it had been post fluid-draining. So it looks like we'll soon be back in the same situation.

I just wondered if anyone had any experience on what my options are now? I'm pretty sure the vet will suggest having the little fella put to sleep, but I'm finding that exceptionally hard to face. We've been through an awful lot together over the years, and I feel like there must be something more I can do before giving up on him.

I've read about the potential for surgery (though this seems VERY specialised?) and other treatments - but wondered if anyone had any tips on what would be involved and what to ask?

Thanks in advance for any help you can offer!

monkeyhat

I have no experience or advice but did not want to read and run.

Someone on here may be able to recommend a specialist vet if you mention what area you are from and are considering operating (if this is an option)

Biscuit is gorgeous

ETA - Found this, don't know it is anything you have not already researched.

http://www.rabbit.org/health/thymoma.html

I have a Rabbit with a Thymoma

I will not be putting him through surgery, which would be major and highly specialised. My Rabbit is on Palliative care which, at the moment, is just an injection of a corticosteroid every 7-10 days. At times he has had a diuretic too. However,this time his last steroid injection was 15 days ago and he remains asymptomatic in that his respiratory rate and effort are normal, his eye are not bulging and his heart sounds can be clearly heard whereas they had been very muffled. We are not too sure why this apparent improvement has occurred.

I think with some situations whilst major surgery/invasive treatment may be possible it does not mean that it is always appropriate to do it. I firmly believe that quality of life ALWAYS comes above quantity. My Rabbit, Murphy, is very happy within himself and I feel we are doing what is right for him.

Surgery is certainly an option and is the best course of action to acheive a cure or long-term remission, but it is very major surgery and there are risks attached. I wouldn't contemplate this until the diagnosis had been confirmed by taking a small sample of the lump (by inserting a small needle, not a surgical biopsy) and having this analysed as surgery may not be the right option if the lump isn't a thymoma.
There are also medical treatments to reduce the size of the growth and slow its enlargement but they won't cure it, only slow progression. If you aren't keen on surgery then this would be worth considering to keep him comfortable for as long as possible.
Marie

Thanks so much for all your helpful, knowledgeable replies.

bunny baby, thanks for the kind words about Biscuit! He is such a knowing, kind, good-natured bunny (despite a serious addiction to chewing carpet), that this is all so incredibly hard.

Jack's-Jane, I wasn't aware of the corticosteroid option - I was under the impression the only choices open to Biscuit were radiotherapy or surgery. Do you know if the use of corticosteroids is because Murphy has a particular type of Thymoma, or whether this is a more general treatment? I totally agree with your comments regarding quality versus quantity of life, though I fear that rabbits inability to communicate pain make it a very complicated decision. Perhaps the least selfish thing to do would've been to have Biscuit put down as soon as soon as he was diagnosed (as recommended by the vet) - but I really I hope I can find an appropriate balance between treatment and not dragging things out for the little fellow. I hope Murphy continues his current improvement!

Marie, do you have any experience with the outcome of this kind of surgery? It's just that it doesn't seem like I should have a sample taken unless surgery is a real option (as it's more upheaval for Biscuit) - and I don't think I know enough to make that decision at the moment. My vet only really told me that the surgical procedure was risky and expensive. Biscuit means an awful lot to me, and I'd like to give him the best treatment possible - but as Biscuit has been mainly healthy through his life, I have no idea what the ballpark of "expensive" would be (the x-rays and ultrasound were almost £600).

I'm going to try and make a follow-up appointment with my vet over the next couple of days to discuss options, but any further advice you can give would be gratefully received.

Thanks again for all your generous help and experience,

monkeyhat.

Hey all,

I have an appointment to see the vet with Biscuit this evening. I anyone has any suggestions for things to raise or ask (I tend to panic and forget everything when he talks about PTS), I'd be really grateful to hear them!

Thanks,

monkeyhat.

Good luck at the vets, if they mention PTS show him this thread and ask if he is aware of these options and to explain them to you.

Could you ask the Vet about a trial of both a corticosteroid and maybe initially a diuretic ?

As I said before, this wont cure the problem but it can buy the Rabbit more 'good quality' time.

Murphy had to have another shot of steroids yesterday as his symptoms returned. Today he is already so much better within himself. The use of steroids in Rabbits is generally frowned upon. But as a last resort I have had several Rabbits who have been able to enjoy several months of life that they would otherwise not have had. But each case needs to be treated on its own merit and what is appropriate for one Rabbit wont necessarily be appropriate for another, even if they have the same illness.

Hi all,

So Biscuit and I visited the vet yesterday, and spoke to him about treatment options. The vet said he didn't feel radio or chemotherapy were a good idea in rabbits due to the potential for damaging other organs, so the options were really to continue draining the fluid from Biscuit's chest where necessary (though he said this might not work for too long if the object was expanding), surgery or PTS. I didn't mention the corticosteroid treatment - it's just that at this stage I'm still clinging to the hope of a longer term solution. I also wanted to explore the options the vet suggested and try not to tell him his job too much :/

I asked for more information on the surgical option and the vet said he would speak to some oncologists this morning and call me with more details.

He just called and said mostly what Marie did a couple of days ago. They first need to find out whether it's a thymoma or lymphoma, as if it's a lymphoma it's likely to have already spread elsewhere in the body - meaning surgery is probably not appropriate. He said there were various ways to get a firm diagnosis - and that the oncologist thought the process would cost around £800 (he mentioned that it was a very complex test). The surgery, if it was possible, would then cost upwards of £3000.

This was a lot to take in, obviously, so I've been chewing it over and shaking out my piggy bank. The main thing stuck in my head is that I would hate to look back and feel like I'd let my little chum suffer and die for the sake of money. I know that might sound daft - but, as a house rabbit (an "only rabbit" too), he's been there for me every night when I've come home for the past 7 years. He follows me around the room when he's out and about, grooms my hair if I fall asleep on the sofa, runs around in circles when he's excited about food, yanks at my trouser leg if he doesn't think he's getting enough attention ... So, with all that soft nonsense in mind, I've asked the vet to pass Biscuit's records on to the referral vet and arrange a consultation for us. Hopefully this should happen early next week.



Fingers crossed, then.

monkeyhat.

Biscuit looks so very proud in that photo He also sounds such a character.

Good luck with the referral, I can understand how you are feeling and it is best to know what you are dealing with before you make any decisions. He is very lucky to have you x

Hey,

When I was looking up about Biscuit's problems a while ago, I couldn't really find a lot of information online. So I wanted to update with his progress just in case anyone comes across this thread when they're in the same position at some point down the line.

It took longer to get a referral appointment for Biscuit than expected. Apparently it was Veterinary Congress last week, and the specialist was away lecturing at that. I took Biscuit back to his normal vet to look at the possibility of getting his chest drained again or using a diuretic. After another ultrasound, they didn't feel there was enough fluid to make either of these options worthwhile, so helped me to push for an emergency appointment with the referral vet as soon as he returned from the Congress. Meantime, Biscuit picked up quite a bit - his eyes have stopped bulging again and he's been more active.

I took him for his emergency appointment on Monday afternoon, and the specialist talked through all the different possibilities, outcomes and options. As Marie said, he wanted to do a fine-needle aspiration biopsy (with the possibility of a biopsy using a bigger needle while Biscuit was anaesthetised if it didn't look like the sample would tell the full story) to be sure exactly what the problem was.

This was done today. When the specialist checked the sample from the FNAB under a microscope, he said it didn't show up all of the three types of cell required to make a diagnosis, so he decided to do the bigger biopsy too. He felt that it was most likely a thymoma based on what he saw under the microscope (I would explain his reasoning for this if I could remember, but I can't) - but wants to wait for the results to come back from the lab so he can be 100% sure.

The specialist was really surprised by how well Biscuit recovered from the anaesthetic, and with this in mind feels that Biscuit would be a good candidate for surgery if it's needed.

I should hear about the results by the middle of next week, so will update Biscuit's progress for future Internet travellers then.

Thanks,

Phil.

monkeyhat said:

Hey,

When I was looking up about Biscuit's problems a while ago, I couldn't really find a lot of information online. So I wanted to update with his progress just in case anyone comes across this thread when they're in the same position at some point down the line.

It took longer to get a referral appointment for Biscuit than expected. Apparently it was Veterinary Congress last week, and the specialist was away lecturing at that. I took Biscuit back to his normal vet to look at the possibility of getting his chest drained again or using a diuretic. After another ultrasound, they didn't feel there was enough fluid to make either of these options worthwhile, so helped me to push for an emergency appointment with the referral vet as soon as he returned from the Congress. Meantime, Biscuit picked up quite a bit - his eyes have stopped bulging again and he's been more active.

I took him for his emergency appointment on Monday afternoon, and the specialist talked through all the different possibilities, outcomes and options. As Marie said, he wanted to do a fine-needle aspiration biopsy (with the possibility of a biopsy using a bigger needle while Biscuit was anaesthetised if it didn't look like the sample would tell the full story) to be sure exactly what the problem was.

This was done today. When the specialist checked the sample from the FNAB under a microscope, he said it didn't show up all of the three types of cell required to make a diagnosis, so he decided to do the bigger biopsy too. He felt that it was most likely a thymoma based on what he saw under the microscope (I would explain his reasoning for this if I could remember, but I can't) - but wants to wait for the results to come back from the lab so he can be 100% sure.

The specialist was really surprised by how well Biscuit recovered from the anaesthetic, and with this in mind feels that Biscuit would be a good candidate for surgery if it's needed.

I should hear about the results by the middle of next week, so will update Biscuit's progress for future Internet travellers then.

Thanks,

Phil.

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I hope all goes well for Biscuit, whatever treatment he goes on to have

Good luck Phil. It sounds like you have found a good specialist.