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

2 weeks ago we sadly lost our lovely girl Puck after nearly 9 years together (she was 11) leaving our lovely boy Ian (8.5) alone. He was ok for the first few days after she passed but then went off his food. For a couple of days he was eating less so I supplemented with recovery and got him into the vets. He had had emergency dental surgery 6 weeks prior to this after seeing a stand in vet who missed the problem so we thought it couldn't be his teeth again. But it turned out it was his teeth and he needed dental surgery THAT DAY. He was coping ok after the surgery, but not eating much alone (loving recovery but not eating lots on hid own unless food is put right under his nose and it takes a long time for him to chew). Since thursday he's gotten worse and yesterday we took him to the vets and she felt his jaw and moved it around and he showed no discomfort and could not see anything wrong when looking in his mouth but she said there was a smell that could indicate an infection, potentially of the tooth root. He's been put on antibiotics and metachlopromide. He was eating bits yesterday but not a lot and by this morning he was refusing to eat anything.

We took him back to the vets today and she said we have two choices, to keep trying or to decide he's been through enough and put him to sleep. He's not in complete stasis but is refusing to eat anything. I'm having to force recovery and even that he's managing to spit some of it out. Right up until yesterday no matter how stressed or ill he's been he's never resisted fibreplex but this morning he wouldnt even take that. The only thing he has taken willingly is metacam. I said I'd like to keep trying so we are still giving the metochlopromide, anti-biotics and feeding recovery and he's had a pain killer injection (as he did yesterday).

For a week after the surgery he was slowly getting better. Eating lots of recovery (only if offered by syringe and warm, but would happily have 15ml at a time) and was taking the odd treat or leaf but taking a really long time to chew. His poos were pretty much back to normal. but from thursday he's been eating less and less willingly. Now he's gone right downhill. She said it wont be a bad reaction to the painkillers or the anti-biotics so to keep going with them and hope we can keep him going long enough for the anti-biotics to start working but if he's not better by monday she said he's been through enough and to put him to sleep.

I feel so bad about the stress we're causing him because she's said to force feed him 10ml of recovery every hour, plus all the meds. I just really hope it works so it feels worth it! He's been through so much in 2 weeks, I feel so bad for him Does anyone know how long antibiotics take to have effect? Am I doing everything I can? Is there a chance he will be OK and would recover from dentals in the future or am I being selfish putting him through this? Thank you <3

What is the name of the antibiotic he is on ?

What is the pain killer called and what is the dose ?

What was the name of the drug given by injection today ?

Did the Vet take skull radiographs when the Dental was done ?

I'm sorry Ian is worse. I know its hard but you are ultimately the best person to decide what is best for him, you are obviously a devoted bunny owner and have his best interests at heart. I think you're early enough into this treatment (antibiotics) to take things one day at a time. Personally I'd try to get that recovery fed over 4-5 sessions if you can get 20mls plus in. My vets always say offer herbs / forage directly after feeding CC as it often stimulates appetite (I found this). This isn't a usual recovery for Ian so this won't necessarily be how he'd be after another dental. You say a vet missed his need for a dental so that delay will likely have caused sores or discomfort, he is grieving & now there is the infection.

What antibiotics is he on & by what route?

InspectorMorse said:

What is the name of the antibiotic he is on ?

What is the pain killer called and what is the dose ?

What was the name of the drug given by injection today ?

Did the Vet take skull radiographs when the Dental was done ?

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No radiographs, I wish I'd thought to ask for that as he's not well enough now for that of course. He's on metacam 0.3 twice a day now and had an injection of Prevomax yesterday morning and again this morning. Today he also had an injection of Buprecare and Vetergesic/buprecare and some subcutaneous fluids.

He's on Sulfatrim antibiotics (0.4ml twice a day) as the vet said they work well for respiratory problems as well as dental as she's not certain where the infection is (though assumes it's tooth root).

He's also on metaclopromide 1ml twice a day.

He's 1.85KG

Thank you, I think one day at a time is the best thing to do. I'm managing to get about 10ml in him at a time, though he really fights it (and spits some out). I fill the syringe to 15 to make sure he's getting at least 10ml even if he splits some out. Do you mean try to get 20ml in him each hour? and 4-5session as in a little bit then a short break? I tend to give 10ml in about 5 goes, giving him time to swallow but could try to up the amount?

He's on Sulfatrim by mouth. o.4 ml twice a day.

Thank you both for your replies! Even just having someone reply makes me feel less alone in this very hard situation <3

Sorry - no i meant reduce number of feeds from 10 to 5 but only if you could get him to take more than 10 ml. I'm off out now but will be back later & will have good think

I would also want the answer to the questions Jane asked, with a view to increasing pain relief dose or frequency, and maybe changing antibiotics.
Antibiotics (oral) usually take 2-3 days to kick in. If he's on Baytril, he may need to swap to a different antibiotic (maybe injectable depocillin?) that will treat infections deeper in tissue.
Skull x-rays should show any pockets of infection or tooth/root abnormalities.

Just went to give him his antibiotics and more recovery and he really fought it this time. I'm now worried not all of the anti-biotic went down as once he was back in the cage he licked around his mouth and spat a chunk of recovery out (though seemed to have swallowed the liquid). I wish they'd given an injection of antibiotic but he's seen 2 vets across the 2 days, both are meant to be very good with rabbits, and neither suggested that as an option. I'm so worried this is the end

The vets advice was to keep trying until monday and if he's the same we need to put him to sleep. I imagine if he's still refusing to eat this strongly by monday he'll be in a worse state also

hes also not really cleaning around his mouth, just leaving the recovery all around it

Just keep going. The fact he is fighting means he's not giving up, although he's obviously not happy. Will he eat the recovery food with a bit of apple or carrot (baby food) puree in it? Or any fresh herbs / dandelion / willow leaves?

PTS is your decision - your vet can only advise. It's always there as an option at any time. If you don't think it's time, you don't have to agree. Discuss all the options with your vet - you are doing a good job under difficult circumstances, and your vets are supporting you and Ian.

Thank you. He normally really enjoys the recovery so until thursday he'd just willingly eat it straight. When he started to go off it I missed in some banana & strawberry baby food puree and it helped a bit but then he stopped and wont take anything. I'll keep trying. Thank you <3

I just have no idea honestly. I feel like he was fine so recently so it feels such a shock to even be considering PTS, but I know things happen quickly with rabbits and obviuosly he's got dental problems already. It's just so hard

I'm so sorry that you and Ian are struggling at the moment, and for your recent loss of Puck. I agree keep going over the weekend, a feisty bunny shows he still has fight in him. You are doing a great job, really hope he turns a corner xx

Pets mum said:

I'm so sorry that you and Ian are struggling at the moment, and for your recent loss of Puck. I agree keep going over the weekend, a feisty bunny shows he still has fight in him. You are doing a great job, really hope he turns a corner xx

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Thank you! To try to reduce stress I was force feeding him on the floor but he was trying to hp away so have started doing it on the counter and he's more compliant, but seems to be eating and swallowing, then once I put him back in the cage he manages to spit a chunk out (thicker than when it goes in so presumably he's at least getting some of the nutrients in the liquid?) He's also used to being out and about so is I think frustrated to be being kept in the cage, but it's easier to keep an eye on him and pick him up for feeds if he's in there.

Every hour is a lot so each time he's more grumpy and refusing to swallow. I'll just keep trying and being as patient as possible. I just really hope that the issue is an infection and the antibiotics are working, but with him already on 2 types of painkillers and still refusing food, is it possible he'll get his appetite back with forcing? Poor bunny

Have you tried him on softer stuff, such as grass or fresh herbs. I had a dental bunny who was always slow to get eating again, but fresh herbs dunked in water were always the first thing she'd manage.

Pets mum said:

Have you tried him on softer stuff, such as grass or fresh herbs. I had a dental bunny who was always slow to get eating again, but fresh herbs dunked in water were always the first thing she'd manage.

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Yes unfortunately we'd tried everything I can think of. In the week after his dental where he had an appetite but was strugglin to chew he ate the occasional bit of kale or parsley but wouldn't really tough anything else. He would also eat a few bits from mixed dandelion salad and the occasional dandelion head, so I thought we were making progress (but slowly). On thursday when he started to go off even his favourites I blended up some green veg and herbs and he ate some of that quite happily but after a few hours even that wouldnt tempt him. He's always LOVED fibreplex and even that he wouldn't touch this morning but he would take his metacam. Now he wont take anything at all without force (and is pushing bits out of his mouth even after it looks like he's swallowed). I even tried a drop of metacam to see if he'd have that but he wouldn't. I think even though he's spitting some out I'm managing to get about 10ml into him an hour. But he gets to a point where he just clenches his jaw and if I squeeze food in he'll hold it for a min then spit it out. And the time for him to get to that point is reducing.

When I put him back in the cage just now he started nibbling at hay but I think he's just biting and dropping (maybe angrily?) and he has cleaned his chin. He also stamped his foot when I put him back which made me feel like there's fight left in him. I've tried fresh grass and he wont touch it, but tbh he's never been very interested in fresh grass. He's got a little piece of banana, some readi grass, some protexin fibre nuggets and some fresh herbs in with him (as well as the timothy hay) but hasn't touched anything yet

This might sound controversial, but I would try leaving him alone with a variety of foods for 8 hours. Check on him from a distance, don’t handle him at all or touch him.

He is obviously very stressed by all the hands on care, giving him a long break from any contact might break the cycle. If he starts to nibble food himself put a plate of softened food in with him, he might lick it from a plate.

Obviously if he eats absolutely nothing during the 8 hours you are going to have to intervene again. But sometimes a hands off approach can work. Also, Vetergesic/Buprenorphine is an opioid which can suppress the appetite in some Rabbits. It can also make them very drowsy. As the effects of the drug wear off the Rabbit can start to feel hungry again.

InspectorMorse said:

This might sound controversial, but I would try leaving him alone with a variety of foods for 8 hours. Check on him from a distance, don’t handle him at all or touch him.

He is obviously very stressed by all the hands on care, giving him a long break from any contact might break the cycle. If he starts to nibble food himself put a plate of softened food in with him, he might lick it from a plate.

Obviously if he eats absolutely nothing during the 8 hours you are going to have to intervene again. But sometimes a hands off approach can work. Also, Vetergesic/Buprenorphine is an opioid which can suppress the appetite in some Rabbits. It can also make them very drowsy. As the effects of the drug wear off the Rabbit can start to feel hungry again.

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That does make sense and sounds like it could work. My worry though is that the vet said he was very dehydrated this morning and I needed to get fluids into him. And I left him for several hours overnight (though I did give him a bit of recovery in the night but didn't have to force at that point) and he's worse today. Do you think now he's had between 60-70ml of recovery today varying in how runny it is, trying to work out how he is happiest to take it) and pain meds he might be ok to be left? He's not drinking on his own so I'm worried about dehydration. No poops since yesterday. Im just really hoping that tomorrow once he's had 2 days of antibiotics that the underlying problem will start to ease and the rest will fall into place, but each time I feel hopeful he gets worse

I would just let him be in his usual space with access to food and water, and just let him settle for a while. Hourly feeding is stressing you both out. I would struggle to do 2 hourly.

He won't poo unless he's had some food - no input, no output. Moving about will help with both gut movement and appetite.

Ok thank you to you both! He's due some meds at 6 so I'll give him them then leave the cage open so he can move around if he likes and leave him be for a while.

Thank you!

Naomi1988 said:

That does make sense and sounds like it could work. My worry though is that the vet said he was very dehydrated this morning and I needed to get fluids into him. And I left him for several hours overnight (though I did give him a bit of recovery in the night but didn't have to force at that point) and he's worse today. Do you think now he's had between 60-70ml of recovery today varying in how runny it is, trying to work out how he is happiest to take it) and pain meds he might be ok to be left? He's not drinking on his own so I'm worried about dehydration. No poops since yesterday. Im just really hoping that tomorrow once he's had 2 days of antibiotics that the underlying problem will start to ease and the rest will fall into place, but each time I feel hopeful he gets worse

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Did the Vet not give him any fluids under his skin or suggest he was admitted for IV fluids and medicating ?

If you don’t already do so offer him water from a bowl. Some Sick Rabbits are more likely to drink slightly warm water or water with a dash of unsweetened fruit juice in it.