STILL ongoing problems with Buster...U/D 30/04/13

Buster is still poorly. I've posted a couple of threads about him previously so I'll just summarise everything to date:

Initial symptoms: increased thirst (up to 650mls per day), increased urination (soaked through large litter tray within 12 hours), dribbling urine outside tray, teeth grinding, rumbling stomach.

Initial findings at vets: UTI - E-coli and Streptococcus (urine caught in litter tray and sent to lab). Heavily sedimented but no crystals present. Had 10 days Baytril and Metacam. No improvement, back to vets for X-rays, blood tests and sterile urine sample. No bladder sludge or stones noted on X-ray, some gas noted in GI tract. No evidence of UTI, however lots of calcium carbonate crystals present in urine. EC titre negative. All blood results normal except neutrophil count low (1.4) indicating infection/inflammation somewhere or possibly a problem with immune system. 6 days of another antibiotic (can't remember name, began with M) and Metacam. Commenced Simeticone for gas pain. Again no improvement, incontinence getting worse. Now has developed a wet bottom.

Back to vets today for X-rays with contrast, no structural abnormalities in urethra or bladder, no fractures in spine or legs which have been missed. Starting on Propalin tomorrow to see if that strengthens bladder muscles and stops the dribbling. Remains on a low calcium diet, has the Supreme Urinary Tract Formula pellets and low calcium vegetables. Unlimited meadow or timothy hay. Continuing on pro-c probiotic at least every other day sprinkled on food.

He's still drinking loads, peeing loads and dribbling everywhere. His tummy rumbles very loudly at times and he grinds his teeth when this happens. Has mostly normal sized poos but some small hard ones passed as well most days. His weight has stayed static over the past month, he is a 6 month old dwarf lop weighing 2.1kg.

Anything anyone can think of that has possibly been missed? Any ideas what could be happening? How can I manage his wet bottom when I can't handle him? Also, he has come back from the vets with a very wet, red eye which he is keeping closed. It looks sore. Thanks for reading if you've got this far x

It is possible that the EC titre test was a false negative if it was done before he had produced sufficient antibodies to give a high titre indicating active EC. A repeat test 4 weeks after the initial one may give a more reliable answer-ie is the titre rising, which would indicate active infection.

Has he had a course of Fenbendazole (Panacur/Lapizole) at any stage ?

The sore eye may be the result of a reaction to the lubricant used to keep the surface of the eye moist when the Rabbit is under GA

If it is still sore tomorrow he will need treatment so you will need to contact the Vet again.

Why cant you handle him ?

Sorry, can't offer any advice, but hope that someone else can help.

We've got to the point we can stroke him, rub his tummy and he'll jump on our laps for treats but he's so highly strung he still won't put up with being handled. I've been reluctant to stress him out since he's been poorly.

He had a 9 day course of panacur when he was about 3 months old. The vet said that the result indicated he hadn't been exposed to EC so I'm a bit confused! Do you think a month course of panacur would be worth trying? My vet has spoken to a specialist who said he was pleased the EC titre was negative, no talk of a possible false negative!

Thank you for your advice, will contact the vets tomorrow if his eye's no better xxx

The only thing I can add to Jane's suggestions is whether or not he has ever had any dental problems and whether his tooth roots were also checked on the x-ray. I'm thinking its highly unlikely at his age to be related to teeth, and suspect that the tooth grinding etc is because of the pain he is in because of infection etc, but I know when Muesli had a distance referral to Richard Saunders it was one thing that was mentioned. I think the theory is that overgrown tooth roots cause so much pain/pressure in the mouth that this causes them to drink excessively and thus urinate excessively. It wasn't the issue with Muesli though as his tooth roots were fine, and I imagine they would be fine in a bun as young as 6 months, but I am no expert by any means.

Otherwise I was wondering if it could be a false negative for EC like Jacks Jane has said.

Sending vibes for him x

sammywoo said:

We've got to the point we can stroke him, rub his tummy and he'll jump on our laps for treats but he's so highly strung he still won't put up with being handled. I've been reluctant to stress him out since he's been poorly.

He had a 9 day course of panacur when he was about 3 months old. The vet said that the result indicated he hadn't been exposed to EC so I'm a bit confused! Do you think a month course of panacur would be worth trying? My vet has spoken to a specialist who said he was pleased the EC titre was negative, no talk of a possible false negative!

Thank you for your advice, will contact the vets tomorrow if his eye's no better xxx

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I'd run the suggestion of a repeat EC titre test by the Vet to see if he/she thinks it to be possible that the first one was done before sufficient antibodies had been produced.

I'm sorry I can't really offer any advice but sending vibes

Going to have a good think about this and post later. Definately agree about EC Titre test being redone as could have been too early to get a reading, and dental issues very much a possibility. Roger had terrible teeth right from the off-set. Isn't that common but not unheard of either. With regards handling him, I have previously had the same problem, but I distracted him by making a fuss of him on the floor, and then my husband was able to scoop him up and wrap a hand towel round him so that he was safe and secure. That's the only way I can think of him.

Have your vets mentioned anything about kidney failure? This would tick all the boxes as well but isn't a great progonosis. Have they mentioned the 2 conditions that they medically refer to as PUPD? Polyuria is greater than normal urine production, and Polydipsia refers to greater than normal water consumption. Obviously I'm not a vet, but it might just be an idea to suggest as nothing else is coming to light. Pain and infection would also be symptons as well. I must admit I did actually think that it was more elderly bunnies that got kidney failure, but the more I think about it, I'm sure there are different types of KF, that can affect any age. I just phoned a friend of mine who had a bunny with KF, and that apparently was the result of inflammation of the kidney which she said was called Pyelonephritis (might be way out on the spelling!!). Her bunny had to have a GA in order for a biopsy of kidney tissue to be taken, and this confirmed it.

The only other info I can add from personal experience with regards to EC, and I lost a rabbit to this, but you haven't mentioned any hind leg weakness or paralysis which is what my bunny had. But just because I had one rabbit with those symptons that had EC, doesn't mean that they all do, I don't know, but I do think if it was likely to be EC, for the time that this has been going on, I think I would have expected you to see such symptons. I have previously managed a bunny with 'wet bottom' really well on Vetbed, because the urine drains away from the rabbit, so that they are not sat in it, and I did have his rear end and legs shaved, as it was much quicker and easier to wash and dry it than with all the fur still in place. I know that sounds a dreadful thing to do at this time of year when it is so cold, but I'm sure it is much colder for them to have wet or damp fur. Because this bunny was quite old, he wore a newborn t-shirt to keep him warm, and there is a company called 'Doggy Style UK' that I admit to buying socks from for my bunny, for his back legs to keep them warm, as newborns are too wide and just kept falling off.

Thank you for all the replies.

Jane, I've been reading up on EC titres and it makes sense that Buster may not be producing a good immune response as his neutrophil count is slighty low. Or he was tested too early post exposure. Definitely something I will discuss with the vet. I'm a bit concerned that he's already had 3 GA's in his short life so don't think I will subject him to that again to get the blood test. However, if the vet is agreeable I may ask for a 28 course of Panacur anyway.

Roger, thank you for your contributions. He has not had any hind leg weakness or shown any other neurological symptoms of EC. The vet did initially mention possible dental problems but ruled this out after the initial x-rays. In terms of kidney failure he is not showing any signs of this in his blood results. He is definitely experiencing polydipsia (up to 650mls per day) and polyuria (large corner litter tray filled with wood pellet litter and hay soaked in 12-18 hours, plus dribbling outside tray) but it's just a case of why :shock: It's certainly not impossible he has a kidney infection but his last urine result was negative and I would expect an infection to travel upwards from the bladder if infection was present? Not always the case I know.

On a positive note, his eye is much better today. His first dose of Propalin was this morning and we have no dribbles and a dry bottom for the first time :thumb: So far so good. Even if the Propalin helps, I still want to know why it's been happening x

I've just re-read your original post and noticed that a Urinalysis doesn't appear to have been done, and this would be really useful for determinimg kidney function. I personally think for all the problems your poor bun has got, that Baytrill would not be the best choice of antibiotic. My own vet who is a rabbit specialist, rarely prescribes it because it is really just for very minor infections, problems, and I wouldn't say your rabbits problems were minor in any sense. The antibiotic that my vet favours and that has always worked on my bunnies is Metronidazole. Maybe it would be worth trying a course of this one, as it is more for the treatment of more serious conditions. It does really sound like the Baytrill is not doing anything.

He's had at least one urinalysis, the first urine sample was a clean catch in the litter tray, urinalysis in house and sent for culture. The second urine sample was obtained by putting a needle into the bladder and obtaining the sample that way. That one was also sent for culture, but not sure if they did a urinalysis that time. As a "human" nurse I would always do a urinalysis before sending a sample for culture but not sure if that's commonplace in veterinary medicine.

He has had two courses of antibiotics, the Baytril was picked as the first urine culture indicated sensitivity to the e-coli and streptococcus that grew. And at that point it seemed like a straightforward UTI, possibly related to bladder sludge or a stone. It was after that things got worse. He had a second course which I can't remember the name of. Began with M but not Metronidazole. I think the blood results came back with a recommendation to use the second antibiotic.

My vet openly admits he isn't a specialist but has spoken to one to get advice and a treatment plan. Thank you for your advice, as I write this I notice Buster 's water bowl is empty, 600mls in less than 12 hours!x

I really hope then that your vet is going to move forward with all of this. It is so distressing for you I know, and I hope it can be sorted soon. If not maybe you need to get a 2nd opinion. The Rabbit Welfare Association would be able to advise you of a rabbit savvy vet closest to you, or maybe contact a rabbit rescue as they are bound to have a bunny expert. So you're a nurse and I'm a paramedic lol.

Update: Buster has now been on Propalin 10 days and there's been a slight improvement in the dribbling. It is still happening though and his bottom is intermittently wet. His stomach still gurgles loudly so I'm giving dimeticone or simeticone 3 times daily (alternating bottles). Back to the vets for a check up today and he's lost 100g in the past 2/3 weeks. I didn't want him to go through another GA to repeat the EC titre so he's starting a treatment course of Panacur in case of a false negative (at my request). Really hope this works, very worried about the weight loss :shock:

Update 30/04/13

I've posted subsequent threads about Buster but have come back to this one which gives the full story from the beginning. Update:

Buster had a 6 week course of Panacur commencing before Christmas and his incontinence got better. He was then weaned off the Propalin over the course of a couple of weeks. He stayed dry for about 2 months before the incontinence returned, slightly wet bottom and leaving dribbles around the room.

Asked for a referral to an exotics specialist. He had a full examination by the vet there. Top to Toe findings: Fluid-filled pockets in eyes (?start of cataracts), slight spurs on back teeth (going to be a dental bun too apparently), weight loss of 320g since finishing Panacur, bladder sphincter weak and urine can be physically expelled with pressure, urine dipstick negative, urine sample sent to lab and has struvite crystals (last time it was calcium carbonate but the low calcium diet seems to have helped that), no urine infection present, repeat EC titre negative, still has a low neutrophil count, X-rays of bladder and urethra repeated and appear normal, blood results otherwise fine, kidney function normal.

When I gave the vet the history and he did the examination he was convinced it was EC not showing up in the bloods. He said even if the titre came back negative again he would treat it as EC anyway. Panacur, Propalin and Metacam restarted. Anyway, when the results came back negative he changed his tune saying it wouldn't be EC with two negative titres. He thought it was the struvite crystals irritating the bladder and urethra and that the Panacur appearing to work was just coincidental.

Panacur was stopped after 28 days and he appeared to be a lot better, not quite 100% but no dribbling and his fur was returning to normal. Two weeks on he is soaked and he's getting smelly. He won't let me handle him so a bum bath is out of the question! I'll go to Pets at Home tomorrow and get some wipes and attempt to clean him up from behind (he's used to me touching his bottom to check if it's dry or not!) Luckily he is an indoor bun, although I'm still worried about flystrike and have applied some protection spray just in case.

Can anyone give me any advice? £1500 later we are only £500 away from our policy limit and no closer to any answers. Personally I think it's EC, the experts appear to disagree. But why would a bun 11 months old be getting cataracts, have urinary incontinence, weight loss and respond to Panacur???? Needless to say I restarted Panacur today and an going to give it continuously for a while, perhaps 2-3 months. Any ideas of how I can get him clean/keep him clean? Any ideas on where to turn next?

I've ordered some vetbed and am just popping out to get some cornstarch powder to try and soak up some of the wetness. I was clearly being optimistic when thinking I could wipe his bum with wipes, no chance!! Running off flicking feet (and wee!) at me :shock:

Sorry I don't have any advice or experience but just wanted to say I hope somebody can offer some advice, it seems like you are having a hard time with little Buster.

I'm no expert but if he is very smelly could you fill the bath with a tiny bit of water and perhaps some hibiscrub (was recommended to me when Poppy had a wet bottom) and have him hop through it a bit and rub his bottom a bit in the bath just to freshen him up and stop his skin getting too sore and then with vet bed he may stay a lot dryer. I found vet bed fantastic with Poppy who wasn't suffering incontinence but had naughty habits as she got older.

Thanks for the advice Janey. Buster is at the vets overnight and having a dental in the morning. Whilst under GA he will be cleaned up. He had spurs developing on his teeth a few weeks ago but these have significantly worsened and need to be sorted. Perhaps he is drinking a lot due to discomfort and because he has a weak bladder sphincter he is unable to hold such a volume of urine. After the dental we'll know more. If the incontinence continues he will have a course of injections which are something to interfere with struvite crystals being formed. They smooth out the lining of the bladder or something. If that also fails then he will have his kidneys looked at in greater detail. His bloods have been normal so far but may be something underlying!

Poor Buster, nothing goes right for him

sammywoo said:

Thanks for the advice Janey. Buster is at the vets overnight and having a dental in the morning. Whilst under GA he will be cleaned up. He had spurs developing on his teeth a few weeks ago but these have significantly worsened and need to be sorted. Perhaps he is drinking a lot due to discomfort and because he has a weak bladder sphincter he is unable to hold such a volume of urine. After the dental we'll know more. If the incontinence continues he will have a course of injections which are something to interfere with struvite crystals being formed. They smooth out the lining of the bladder or something. If that also fails then he will have his kidneys looked at in greater detail. His bloods have been normal so far but may be something underlying!

Poor Buster, nothing goes right for him

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Aww bless him, I hope having his dental done helps so that he doesn't have to have all the other work. I used to feel the same about my Poppy, although she didn't have as many issues as Buster I felt she was constantly at the vets, having meds, bein poked and prodded. But at least he has an amazing owner who will do everything possible for him, that's what I used to tell myself when I felt awful for Pop. Hope that the dental has gone well and you see an improve,ent in the little guy.x.