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Poppy - severe dental and abcess - surgery or not?

Jacq

Warren Scout
Poppy is nearly 9 and today we had a CT scan done. She started having trouble with eating hay towards the end of November but even now, she is still eating softened pellets, finely cut herbs and the occasional pureed veg. At first our vet advised just to keep an eye on it, then an abscess appeared and Poppy had an x ray, teeth burred and the access drained as much as possible. Current medication is metacam, Metronidazole antibiotic ( last 3 weeks) and from today baytril.
Outcome of the CT is that Poppy has 6 lower teeth to be removed and the corresponding upper teeth, pockets of abscess to be removed and a larger abscess that is currently under her chin but also extends up into her jaw. The bone is also showing signs of osteomyelitis.
Prognosis gives only a 30% chance of removing all infection through surgery and 3 months at least of antibiotics and flushing a large wound. There is a risk that with the length of the surgery she may not come through it. The alternative option is palliative care. She is showing small signs of distress when having her meds but since she has been home today, she has eaten approx 15g of basil, drinking, used her litter tray, groomed her husbun. She doesn't appear to be giving up. So I suppose the question I'm asking is - should I? If we go ahead with the surgery it will either be tomorrow or Wednesday.
Sorry for the long post.
 
I’m sorry you and Poppy are in this situation :cry: I’ve not got experience of this specifically so I can’t advise, but I’m sending lots of vibes xx
 
I've no experience of this either. I have had a rabbit, who had a cheek abscess removed surgically, but nothing on the scale of what is being proposed for Poppy. I also have a nearly 9 year old rabbit and I was thinking how I would feel faced with this decision and the answer is I really don't know :(

I think a lot would depend on how much faith/confidence I had in my vet. I also wonder about the stability of her jaw with such major surgery and particularly if there is already osteomyelitis.

One thing I probably would consider, if she will need long term medication with either option, is to discuss with your vet the option of giving the drugs by injection if she is becoming distressed by being medicated orally. After my rabbit's abscess surgery I gave her Penicilin injections, which not only seemed very effective, but also were tolerated very well by my rabbit.

I cannot give you any advice on what to do. It is a really horrible decision to have to make. Sending you lots of hugs though and also loads of vibes for Poppy.
 
I'm so sorry to hear about Poppy's dental problems, but pleased that she is managing to eat and still interact with her husbun. I've no advise to offer I'm afraid, as I too have no experience of this situation, so I'm adding my vibes for Poppy. My best wishes to you and Poppy, whatever you decide xx
 
I have had 2 rabbits in a similar position. It was some years ago, so I don't remember all the specific details.

They were referred to FHB in Harrogate for treatment. The abscesses were removed as far as possible. She said it wasn't uncommon for the jaw to break, but not to worry about it. One if the rabbits didn't really have any effective use of one side of his jaw anyway due to diseased bone. Some of his teeth fell out during the ops, so didn't need removing. Both had subsequent minor dentals to keep the remaining teeth in trim.

The open wounds were flushed twice a day and packed with manuka honey, and allowed to heal slowly. They were on pain relief daily and depocillin injections daily or every other day for the rest of their lives (about 18 months).

Food had to be provided in a way that they could eat it - grated or finely chopped, softened pellets on a saucer, leafy branches hung up so they could pick the leaves off (rather than struggling to get them off the floor), grass cut up into very short lengths (0.5cm?) with scissors. If they needed it, the pellets were fully mushed up with some baby food puree and left on a saucer so they fed themselves, or for top-up syringe feeds. We monitored their weight weekly to make sure they were eating enough.

The one problem we had was avoiding flystrike on the open wounds. I used F10 germicidal wound spray with insecticide spray as needed - you can use it on open wounds daily.

We just got used to the routine. Both rabbits had a good quality of life. I would do it again if needed.
 
If you are not sure, don't rush into a decision you are not happy with. You can also ask to be referred to a dental specialist in person, or ask your vet to consult one with the CT scan results (by phone / letter / email).

There is nothing wrong with palliative care (even the surgery isn't going to fix everything, so that still counts as palliative). I would query the use of baytril for abscesses, though. It can't penetrate the abscess / capsule so (as far as I am aware) is not worth trying in this type of case. I would be asking for long term depocillin or similar. Metronidazole is another standard abscess treatment, but I have no experience of its use. An anti-inflammatory (eg metacam) may also help keep the symptoms under control and improve quality of life. A rabbit with dental pain won't eat well This is likely to be for the rest of the rabbit's life.

You may need ongoing dental treatment to maintain the remaining teeth which are not being ground down by food as they normally would. That would be needed anyway - with or without the major abscess surgery. It also gives other opportunities to deal with the abscesses.

If she is eating and maintaining her weight (check it weekly), you have time to think about it. Rabbits can cope with quite a lot if they are cared for appropriately. Mine had a good quality of life up to about the day before they died, when they deteriorated very quickly and it was obvious that the infection was overwhelming. One had so little useful lower jaw that I was offered the option of removing half of it. I declined, as he was coping well and it seemed extreme for no additional benefit.

I wish you well with whatever option you take.
 
Thank you Kattymieww and Shimmer. I’ve heard that a few times about baytril although both my usual vet and the vet I saw yesterday (RWAF) have prescribed it along side the antibiotic and metacam. Is it a throw every thing at it and hope it works approach?
Having spoken to my vet this morning we have decided against surgery and will continue with the antibiotics. We feel that as Poppy still has a quality of life at the moment compared to the stress of any surgery and follow up treatment.
The vet who did the CT explained that the prognosis Wasn’t very good with only a 30% chance of a full recovery and long term treatment would still be needed. Also given her age, the length of surgery and a high risk she wouldn’t come through the anaesthetic.
I have to monitor her weight at home and we have a check up in 2 weeks, although poppy will probably require a dental by then. I think we’ve done what’s best for her, I hope so.
 
Thank you Kattymieww and Shimmer. I’ve heard that a few times about baytril although both my usual vet and the vet I saw yesterday (RWAF) have prescribed it along side the antibiotic and metacam. Is it a throw every thing at it and hope it works approach?
Having spoken to my vet this morning we have decided against surgery and will continue with the antibiotics. We feel that as Poppy still has a quality of life at the moment compared to the stress of any surgery and follow up treatment.
The vet who did the CT explained that the prognosis Wasn’t very good with only a 30% chance of a full recovery and long term treatment would still be needed. Also given her age, the length of surgery and a high risk she wouldn’t come through the anaesthetic.
I have to monitor her weight at home and we have a check up in 2 weeks, although poppy will probably require a dental by then. I think we’ve done what’s best for her, I hope so.

I am late to this thread, but I think you have made the best decision for Poppy x
 
It sounds like you have made the best decision for her, I’m sending lots more vibes xx
 
I'm pleased that you have come to a decision, and treatment plan. Really hope that Poppy can remain as comfortable as possible for as long as possible xx
 
Your poor girl!

I was about to go in to great detail of my Nancy's facial abscess. However hers did have a specific cause (hay stuck between 2 dodgy teeth). Luckily my vet was able to remove the capsule as well as drain the pus, plus Nancy was only just turned 6 years old.

Poppy's issues seem much more complex.

I would just ask if your vet has sent anything to the lab for analysis to check which antibiotic will be best? Nancy started on the broad spectrum Baytril but after analysis switched to a different one -The name of which escapes me but it smelled of oranges.

Sending loads of love and vibes for Poppy.xx

Sent from my SM-G960F using Tapatalk
 
Thanks Den, I'll ask the question when I book her appointment tomorrow.
At the moment, Poppy is tucking into a bowl of chopped kale after having her meds.
 
Nice to hear she is enjoying her tea. Best wishes for her, I hope the treatment plan gives you lots more time with her
 
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