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PLEASE HELP Dental problems and not eating:Vet suggested potential PTS

Shimmer said:
Why is he on additional pain relief (ie tramadol or vetergesic)? I've only been given those after major jaw surgery. I usually get permission to increase the metacam for a few days.
Was he weighed again? It's useful to weigh weekly just to keep track of his general condition and food intake.
It's a long way off until your vet is on holiday. Fingers crossed Ian is feeling much better by then, even if you are still having to provide some additional support.
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She thinks the reasons he's not chewing/takes a very long time to chew when he does is because of pain from a tooth infection, and because we saw a change from yesterday to this morning when he came of the vetergesic she said to try tramadol (0.1 ml twice a day). I'd already upped his metacam to 0.5 last night and this morning (based on a previous dosage he'd had post surgery) and he seemed less alert and less interested in food this morning and just looked uncomfortable. We've upped the metacam to 0.5 twice a day going forward too but she didn't want to up it too much because of something to do with it and dehydration. He was weighed and was 1.82ish compared to 1.85 last week so not a big change. I'm going to buy some baby scales to weigh him going forward because our method of putting him in a big bowl on our kitchen scales is probably a bit stressful for him at the moment and probably not as accurate.

Our vets last day in is this Thursday so she said I can contact her on that day if I need to but otherwise she told me one of the newer vets has a rabbit himself and has an interest so I might try him if I need to go back while she's gone.

He's had a tiny nibble on some dandelion leaf this evening (I put it right to his mouth and he went to nudge it away then nibbled a bit, so not incredibly enthusiastically but did have a bit).
 
Hmm it's a tough one with the pain meds because if he's still in pain then he's going to be very reluctant to eat but tramadol is also an opiate so you're back to the potential issue of him getting too zonked out to eat. I can see where your vet is coming from though as the priority at the moment is pain management. Ian may cope a bit better with the tramadol than he did with the vetergesic and his subdued demeanour might just be down to stress from the vet visit this morning. I'd see how he does over the next couple of days with the tramadol.
 
Antibiotics sure can take some time to take effect in older rabbit even more so. The healing process it self is slower. The main thing is to treat the cause and have the right combination of meds. The more specilised, exotic vet clinic is the bigger variety of meds they have.
 
Scrappy's Little Helper said:
Hmm it's a tough one with the pain meds because if he's still in pain then he's going to be very reluctant to eat but tramadol is also an opiate so you're back to the potential issue of him getting too zonked out to eat. I can see where your vet is coming from though as the priority at the moment is pain management. Ian may cope a bit better with the tramadol than he did with the vetergesic and his subdued demeanour might just be down to stress from the vet visit this morning. I'd see how he does over the next couple of days with the tramadol.
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He's actually perked up a little now. Still refusing food off me but is nibbling at hay and is definitely chewing at least some of it, not just biting and dropping. Could be the stress easing from the vets or could be the tramadol wearing off as it's 9 hours after his first dose. Will keep an eye on if the pattern happens again after the next dose. It's so sad for him to be annoyed when he sees me, that bit is quite hard. He's been stamping his foot when I walk in the room whereas before he would run over to me and hop round my feet. Just wish I could explain it all to to him!
 
Bunnies are very forgiving. When medicating or during feeding I always allow plenty of time between bites for some nice rubs and cuddles. Even so, I feel like a bully given our size difference. Then I realize they are tough for their size .
I have never had a bunny hold a grudge.
 
You and Ian are doing well to keep his weight up, so he must be getting a reasonable amount of food down him. I hope he continues to improve.
 
bunny momma said:
Bunnies are very forgiving. When medicating or during feeding I always allow plenty of time between bites for some nice rubs and cuddles. Even so, I feel like a bully given our size difference. Then I realize they are tough for their size .
I have never had a bunny hold a grudge.
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I know what you mean. I'm doing stroking and breaks during feeding but I think he's reaching his limit. It's all just made so much harder by him losing his companion 2 weeks ago. He must be so frustrated and confused by what's happening :( I'm not sure how long is fair to put him through this as he's still not really eating any more than a few nibbles a day on his own. Really hoping once he's been on the ABs a week we see an improvement.
 
I really hope that the antibiotics start to make a real difference for him, I'm sure he'll feel more like eating then. Keep going Ian, you are in very good hands, sending you loads more get well and eating vibes xxx
 
thank you! One thing that I'm a bit concerned about is the vet said to go down to once a day for the metochlopramide and when it runs out (which it will soon) that I wont need more. I asked if I could have more and she said it's to get the gut moving again and now he's pooing to ween him off it. In the past he's recovered from GI stasis much faster (when there weren't the added complications of grief and infection) so his poos were back to normal by the time we ran out of gut stimulants so I'm a a bit worried. Should I call and push for more? He's been on it since last thursday now
 
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I'm also wondering if I need to reduce the amount I'm giving him each feed to see if that will get his appetite up as I'm getting about 30ml into him (making the mixture more watery so he's getting more water) and that's every 3 hours. But then we gave him a bigger break over night last night and he hadn't seemed to have eaten and wasn't any more keen on syringe feeding this morning.
 
apologies for 3 separate messages. I bought some dandelion and plantain mix (dried) and I opened the bag and he was interested and stuck his nose in it, then I gave him a piece of I think plantain and he excitedly took it but then chewed it for about 5 whole minutes before dropping it (soggy and stringy) out of his mouth. then he continued to 'chew'. I'm noticing he's not rally making chewing sounds either, even though his mouth is moving that way. Maybe because he's chewing small pieces for so long that they aren't crunchy anymore but I'm wondering if he just can't chew properly? The vet did put his teeth together and mimic a grinding motion and he didn't seem uncomfortable but could his jaw be out of whack from the dental? or is he more likely to be chewing lightly/not properly because of pain? Our vet practice has silver standard from the rabbit friendly vet awards and won rabbit friendly practice of the year a few years ago because of our vet so I'm assuming she's very knowledgable but of course they don't see them at home like we do so I'm worried things might have been missed. Again, can't thank you all enough for continuing to respond! It means so much!
 
If he's not eating normally by himself, he needs you to keep feeding him. Will he take recovery food from a saucer?
Dried dandelion & plantain: can he eat it if you eg cut it into spaghetti strips, so he can 'suck' it in?
Metaclopramide: if he's eating well and poo is completely back to normal, he probably doesn't need it. If not, I would be reluctant to stop it.
I would suggest he needs skull x-rays as well - your instinct is that there's something going on that's not been spotted yet. I would trust your instincts, as you know him best.
What you are doing is keeping him stable and slowly making progress, and it takes a lot of effort to get there. If you stop, I suspect he will regress again. If he presented just as he is today to a different vet, what would you want them to do?

I'm obviously not a vet, so not qualified to diagnose & treat, but I have had several rabbits with odd and severe dental issues and gut instinct has served me well. It's always worth having another discussion with a rabbit savvy vet and advocating for your rabbit. I try to look at all options - what the outcome would be with and without taking that option. You need to weigh up whether reducing / stopping what you are doing is going to better or worse than continuing it for now, and review again as needed.
 
Shimmer said:
If he's not eating normally by himself, he needs you to keep feeding him. Will he take recovery food from a saucer?
Dried dandelion & plantain: can he eat it if you eg cut it into spaghetti strips, so he can 'suck' it in?
Metaclopramide: if he's eating well and poo is completely back to normal, he probably doesn't need it. If not, I would be reluctant to stop it.
I would suggest he needs skull x-rays as well - your instinct is that there's something going on that's not been spotted yet. I would trust your instincts, as you know him best.
What you are doing is keeping him stable and slowly making progress, and it takes a lot of effort to get there. If you stop, I suspect he will regress again. If he presented just as he is today to a different vet, what would you want them to do?

I'm obviously not a vet, so not qualified to diagnose & treat, but I have had several rabbits with odd and severe dental issues and gut instinct has served me well. It's always worth having another discussion with a rabbit savvy vet and advocating for your rabbit. I try to look at all options - what the outcome would be with and without taking that option. You need to weigh up whether reducing / stopping what you are doing is going to better or worse than continuing it for now, and review again as needed.
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Thank you for replying. I've tried him again with the plantain (it is in fairly small bits already) and he managed to chew and swallow it, but was bored after 1 piece. He wont eat anything unless I put it right up to him. He was enjoying some banana and apple puree from a syringe but when I put it on a spoon or small plate he wouldn't touch it. He's taken it upon himself to nibble at a bit of lettuce on occasion but that's it. And the nibbling of hay (but can't really tell how much is actually going down). OUr vet thinks that the infection is affecting his sense of smell (or is what he can smell) so food doesn't smell right or is not strong enough for him to want it.

I think you're right about changes as he's already had the change of the pain meds recently so I'll keep going with what we've been doing until I can see he has more interest in food. I've also rang the vets and asked again about prescribing more metochlopramide. I'll not hear until tomorrow but I have a dose for this evening. I can't really find a vet who is more recommended than the one I have, she's been mentioned by name in different threads on forums for good rabbit vets (that's how we found her) so I'm not sure who else I could try in the area. We had a great vet when we lived further north who was great with rabbits and rats but I think the long journey (over an hour) would be a lot for him too. I think with the skull xray we do need one eventually but not sure he could take the GA right now as he's so stressed and unwell already :( . I guess as far as the vet is concerned, it seems that it's pain causing the not/very slow chewing so until there's been long enough for the ABs to have effect maybe I need to just be patient. It's just so tough seeing him like this! You're right about going with your gut so I'll keep trying to do that, balancing the stress of more/changing intervention with the risks of not is so hard!
 
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I really feel for you, it's so hard looking after a poorly rabbit that won't/can't eat, but I agree to go with your gut as far as feeding is concerned. Hopefully the meds will kick in and he'll start to feel better soon. Please post anytime if you feel overwhelmed, we've all been there and even if we can't help, we can listen and support. Sending you a big hug xx
 
Pets mum said:
I really feel for you, it's so hard looking after a poorly rabbit that won't/can't eat, but I agree to go with your gut as far as feeding is concerned. Hopefully the meds will kick in and he'll start to feel better soon. Please post anytime if you feel overwhelmed, we've all been there and even if we can't help, we can listen and support. Sending you a big hug xx
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Thank you <3! The support from you all means a lot! I think I'd have lost my mind completely by now without all the support and advice! <3
 
I'm not suggesting you change vets when you have a silver rated one that you are happy with, plus the stress of each visit anyway - just that it's worth taking a step back at times, and that he doesn't seem stable enough from what you are saying to stop what you are doing. My thought was: If a vet saw you now for the first time, would they suggest metaclopramide with the current symptoms (rather than he's already had X day's worth, so that's it)? It's a matter of getting this across without causing friction, especially as you have come this far. Ask why they want to stop when he's not eating well enough to sustain himself without additional feeding at the moment, so there is the risk of continued gut stasis - and if there is any harm in eg another week, then review, just to be on the safe side.

Maybe collect a day's worth of poo to see what he's actually producing, plus weigh him next time you go in. If his poo is completely normal in size, quantity & consistency, and he's at the same weight, fair enough - he's just needing support with feeding rather than gut motility.

I've had rabbits on metaclopramide for several weeks before, so my feeling is that the risk of prescribing a longer course is less than the risk of stopping it. It may be harder to get back to where you are if he goes back into stasis.

I also don't want you to be put in the position of the vet asking you to consider PTS again when you don't actually know what the cause of this episode is, and he's doing well with the additional care and is bright enough in himself. It's still relatively early days for the antibiotics as well. I would want to discuss / exhaust all reasonable options first (and maybe a few unreasonable ones as well - my vets know me well :lol: - but that's how we learn). A lot of people are not able to provide the additional support you have, so that should be taken into consideration as well. There is still a bias towards people not wanting to spend that much time or money on a rabbit, so may be more readily offered PTS than for other species.


Don't forget - You are doing a brilliant job.
 
Cisapride might be a better prokinetic than metoclop’, or they can be given together. Metoclop’ only increases the rate at which the stomach empties and has no effect on the hind gut. Cisapride improves hind gut motility.
 
Shimmer said:
I'm not suggesting you change vets when you have a silver rated one that you are happy with, plus the stress of each visit anyway - just that it's worth taking a step back at times, and that he doesn't seem stable enough from what you are saying to stop what you are doing. My thought was: If a vet saw you now for the first time, would they suggest metaclopramide with the current symptoms (rather than he's already had X day's worth, so that's it)? It's a matter of getting this across without causing friction, especially as you have come this far. Ask why they want to stop when he's not eating well enough to sustain himself without additional feeding at the moment, so there is the risk of continued gut stasis - and if there is any harm in eg another week, then review, just to be on the safe side.

Maybe collect a day's worth of poo to see what he's actually producing, plus weigh him next time you go in. If his poo is completely normal in size, quantity & consistency, and he's at the same weight, fair enough - he's just needing support with feeding rather than gut motility.

I've had rabbits on metaclopramide for several weeks before, so my feeling is that the risk of prescribing a longer course is less than the risk of stopping it. It may be harder to get back to where you are if he goes back into stasis.

I also don't want you to be put in the position of the vet asking you to consider PTS again when you don't actually know what the cause of this episode is, and he's doing well with the additional care and is bright enough in himself. It's still relatively early days for the antibiotics as well. I would want to discuss / exhaust all reasonable options first (and maybe a few unreasonable ones as well - my vets know me well :lol: - but that's how we learn). A lot of people are not able to provide the additional support you have, so that should be taken into consideration as well. There is still a bias towards people not wanting to spend that much time or money on a rabbit, so may be more readily offered PTS than for other species.


Don't forget - You are doing a brilliant job.
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Thank you! This is all really helpful. I see what you mean about a different vet and what I would expect, that's a really helpful way of thinking about it (unfortunately with our rabbit vet going away for 3 weeks we might have to seek the opinion of another vet soon but apparently one works at the practice who has bunnies so I'm hopeful they will get it!). It's tough because obviously I trust our vet and wouldnt want to say she's wrong of course, just we see them more and sometimes with short visits you worry if they haven't caught something. But I think you're right about the metoclopramide, and it's great to know about the other type of stimulant too InspectorMorse! I'll ask about that tomorrow before she goes on leave. His poos are definitely not back to normal so I'm going to push for some sort of stimulant at least until it seems the ABs have had enough time to have some effect. Thank you again! It's so helpful to just type out my thinking and worries and the advice is so great! Sending thank yous from me and Ian (though he's not feeling very grateful yet, I hope he will soon!)
 
Sending more get well wishes for Ian. You've tried so much & obviously truly dedicated to his care. Plumpkin (a much loved bunny on here who had extreme dental issues) used to love a kale smoothies (I think just kale & water blended) off a saucer. Maybe worth a go.

My less used but much more local silver accredited practice started using cisparide during lockdown when couldn't get metaclop & experienced much better results so stuck with using it
 
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