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Arthritis of the Jaw - Quality of Life

Beapig

Mama Doe
Hi everyone,

Long time no post. I feel bad coming on here just to ask for advice again, but I find RU to be the most warm, helpful and educated rabbit community on the internet.

I'm really just looking for some advice and reassurance about how to proceed with my rabbit, Lily. The last time I posted, she was about to have a CT scan after a major health scare which resulted in days of hospitalisation and an emergency dental. We had all sorts of worries about what was going on in her mouth, let alone some abscesses suddenly appearing on her elbows. This was back in August 2023 and we had also just moved house, so it was an overwhelming time to say the least.

The CT scan revealed that she has arthritis on one side of her jaw/TMJ. This is what my vet wrote to me when they received the scan results:


"The report shows that the dental disease is not too severe thankfully, there is mild/moderate dental disease present, but thankfully, no abscess associated with a tooth root etc. Any pus observed likely to be as a result of infection in the ulcers in the cheek, secondary to the dental disease. It would be interesting to see whether there is still any pus visible.

But the CT has revealed the likely cause of Lily not eating - she has very severe arthritis in her left temporomandibular joint (the joint between the skull and the jaw). There is new bone formation there but also sclerosis (where the joint has started to "fuse"). I think this means that opening and closing her mouth and chewing are likely to be quite painful. It's a difficult problem for us to solve - I don't think we can cure it, it will be a case of ensuring suitable ongoing pain relief to try to provide her with comfort and potentially, may also involve us offering her some softer foods on an ongoing basis. If she'll take something like Oxbow or Emeraid from a dish, it may be worth offering this. If she is struggling to eat/losing weight despite pain relief, ongoing syringe feeding may need to be considered. Unfortunately, if we get to a point where we can't keep Lily pain free, then at some point we have to consider quality of life."



Going on from here, we decided to try Lily on some strong medication to see if we could manage her pain, with the mindset of we will only keep her going if she is not suffering. We started Lily on a combination of Loxicom and Tramadol, but found that the Tramadol was making her really drowsy and spaced out. It was also costing almost £250 every three weeks, which was not easy for us to afford on our income. On the Tramadol it was hard to tell if she was in pain or just spaced out.

Subsequently we had to change vets, as our wonderful previous vet was now over 2 hours away. Thankfully we found a great new vet only 5 mins from our new home. After going down a rabbit hole, I asked my vet about Calpol instead of Tramadol, and we tried that alongside Metacam with success. I educated myself on the rabbit grimace scale and have been carefully keeping an eye on her body language and how well she was eating. She was doing really well given her condition up until November 2024 when she suddenly seemed off again. We booked her in for a dental and she had a couple of spurs removed, but nothing severe. There were 8 months between dentals, which to me seemed quite a good amount of time given her arthritis.

However, she has gone downhill gradually since November. Her weight was maintained at 2.5kg up until Nov, but has gradually slipped to 2.3kg. She is VERY affected by temperature, so we keep the door to their room closed at all times with a temperature gauge and their own special plug in heater. I try to keep the temp above 20C at all times, although there may be a few hours overnight where it drops when I'm asleep. As she can only eat grass, not hay, this is another struggle. I am finding it difficult to forage enough on a daily basis. So much of the grass is covered in rust, or has simply died back to nothing. Luckily my neighbour lets me hand cut grass from his field, but I know she's not getting enough to keep the weight on, and I'm worried it is also affecting the speed at which spurs are re-growing.

They were both vaccinated last week, and the vet said he could see a slight edge on one molar forming. I'm wondering if this could be enough to make her 'off' again. She's not eating her grass with relish like she did in the summer. I'm also concerned that her mouth always feels damp to the touch. I have never had a rabbit 'drool' before, but I wonder if this is the early stages of drooling.

My biggest fear is that the arthritis has worsened in the last year and half, and that the meds aren't enough for the pain anymore. She still eats pellets, dried herbs and fresh brambles/plantain/leafy stuff okay. Could it just be one spur causing all of the problems, and the cold/not enough grass meaning only 2 months have passed and she needs another dental already?

Any advice or thoughts would be hugely appreciated. They are both (Lily and Maple) almost 9 years old now, so getting on in age, but Maple is in good health. The hardest thing is that they are VERY bonded as sisters, and I dread to think how Maple would cope without her sister if we had to make that decision. Partner and I don't think we are in the right place for more rabbits at this time; financially we have spent thousands on Lily's condition. The house we moved to needs a lot of work and we'd like to get up straight before potentially adopting another pet in the future.

Thank you so very much for reading. I'm going to see if I can find some photos from the CT scan to upload as well.

Edited to add: CT scan report:

Screenshot 2025-02-03 at 11.17.31

Screenshot 2025-02-03 at 11.19.02
 
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If there's a confirmed spur, it could be enough to cause issues and is something that can be sorted out.
Meanwhile, are you syringe feeding at all? I would increase the quantity of whatever she will eat and add some syringe feeds to try to get her weight back up a bit. Thankfully, everything is starting to grow again now - so forage is getting easier to find. She may be finding it much harder to eat grass if she doesn't have full jaw movement, so you may have to make adjustments there - maybe cut it into tiny bits and mix with CC on a saucer?
 
If there's a confirmed spur, it could be enough to cause issues and is something that can be sorted out.
Meanwhile, are you syringe feeding at all? I would increase the quantity of whatever she will eat and add some syringe feeds to try to get her weight back up a bit. Thankfully, everything is starting to grow again now - so forage is getting easier to find. She may be finding it much harder to eat grass if she doesn't have full jaw movement, so you may have to make adjustments there - maybe cut it into tiny bits and mix with CC on a saucer?

I'm not syringe feeding as she finds being syringed her meds twice daily really stressful, to the point that she'll hide the moment I enter the room. So I've been trying to reduce her stress as much as possible. If I gave her more pellets she would happily eat a whole bowl full, so I could try that, but would have to make sure she is away from her sister who would also scoff them otherwise.

I suppose my worry/fear is that if she doesn't eat enough grass, she'll keep getting painful spurs and the cycle with continue. It is why I have been questioning quality of life, but equally she may be a lot better in the Spring when I can forage a lot more. We live on a smallholding and are very rural, so in Spring/Summer/most of Autumn I can get an abundance of greens for them, which is great.
 
I agree the spur may be bothering her so a dental may get her back eating grass. Though also provide her with more pellets. This may buy you time until the weather gets warmer and forage easier.
Sending vibes.
 
I can't really offer any more advice, just wanted to send lots of vibes for your girl, she's lucky to have you caring for her so well.
 
Just wanted to pop in and say hello :D Living on a smallholding sounds very interesting!

I'm sorry about your concerns with Lily, which I completely understand. Plants are starting to show signs of new growth, so it's only going to be a few weeks before there's a lot of lushness outside.

Regarding feeding Lily, I would just try to give her more of what she's able to eat, whilst preventing Maple from eating too much. I would recommend giving her Fibafirst sticks if she'll eat them. Unlike pellets, a bunny can run off with one and eat it. They also are reasonably calorific and so could prevent her from losing too much weight.

I would also consider getting the spur sorted out.
 
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