Critical Care dosage seems to be low

[Mara]

I desperately need feedback about Critical Care dosage.
A month ago, my rabbit started losing her appetite, and the appetite is getting worse despite the treatments. She was seen by several vets, the last one was a veterinarian that is certified in exotic animals, so he should be one of the experts in our area.

He prescribed her new meds and told to feed her 21 ml of wet (mixed) critical care 3 times a day. So, 63 ml in total. She weights 1.25 kg.

To me, it looks like a very low dosage...
The Critical Care package tells to feed more: 3 tbsp (or 27 g) ... it's 120 g of mixed product
The Dosage Charts on Oxbow site tell to feed 5.75 tbsp (or 52 g) ... it's 224 g of mixed product

The vet declined to explain how he decided how much CC she needs, no matter how much I insisted that I need to understand why the dosage is small, and what guidelines do they use. He replied only that he calculated it himself, everything is correct, that they have always given rabbits this dosage, it worked for them.

So, now I follow the vets advice and give her 15 g of dry CC (or 65 g of mixed product) per day, but I'm afraid she might go into stasis on this portion since she barely eats anything on her own. Does this dosage look small to you?

(For the reference: when she is healthy, she easily eats 80-90 g of dry matter per day.)

 

[Shimmer]

I've always gone with what it says on the packaging and it's worked for me, assuming that the rabbit isn't eating very much (if anything) on their own. Adjust accordingly if they are. Weigh the rabbit regularly (weekly) to make sure they are maintaining their weight and increase the amount if needed (losing weight, small poo, etc).

21ml per feed and only 3 feeds a day doesn't sound like a lot if that's all they are eating, IMO. My rabbits are usually around the same size as yours and I would be aiming to double that amount of feed over 24 hrs (which is in line with the manufacturer's recommendations), and more if they would take it and need to gain weight. I tend to do 4 feeds a day (so around 30ml per feed) if it's a longer term situation, and more often if they won't take the volume. Some of it depends on how much the rabbit will put up with being handled.

Mixing in a little baby food puree (such as apple, pear or carrot) helps to syringe the food more smoothly and can make it more palatable to the rabbit. I tend to use a small jar (such as a baby food jar) to make up enough food for each day and keep it in the fridge between feeds. That makes it easier to judge how much they are eating and to adjust the routine as required. You may need to add a bit of warm water to each feed as it tends to thicken up on standing.

 

[bunny momma]

Did the vet diagnose a reason for her not eating? Is she pooping an appropriate quantity for the amount she eats?
Pain, including dental spurs/points is a common reason bunnies stop eating. Pain meds may help in some cases, yet the underlying issue should be addressed, if possible.
Does your bunny accept the syringe feeds? Does she seem hungry enough to want more?
If no obstruction in gi is suspected, and syringe feeds are not causing the bunny excessive stress, I let my bunny decide when they had enough, though I would give more frequent feedings rather than giving larger feedings so their tummy had time to empty.

Sending vibes for your bunny.

 

[Mara]

Thank you!
The reason is still a mystery. It doesn't look like GI stasis because she is an extremely active and playful rabbit. Only her appetite is the problem.
Bloodwork, fecal tests - normal.
Her teeth have tiny spurs, but no lesions on the tongue. The doctor told that tiny spurs don't bother most rabbits, but if she is oversensetive, there is a possibility spurs are the reason. I watch how she acts around food, IMO it doesn't look like spurs. It looks like a loss of appetite.

Her droppings are mostly normal, but sometimes she has tiny droppings (usually just for a houer or two, not the whole day). In the last year, from time to time she had huge oval droppings (looking like megacolon droppings), so the vet had an idea that this could be dysbiosis. He told it's impossible to test if she actually has it, we can only give her meds to "reset" her flora and see if she gets better.
For now, he decided to go with dysbiosis treatment.

She accepts the syringe feeding, but is annoyed lately since it continues for so many weeks. She looks hungry only in the evenings, in the mornings she doesn't eat well and spits out a lot of Critical Care (though her stomach feels almost empty in the mornings).

For the last 2 days she looks sleepy and passive, but possibly it's after the sedation at vet (for bloodwork) and because of new medications.

 

[Shimmer]

Small dental spurs can be enough to stop a rabbit eating. There doesn't have to be soft tissue damage as well. If the rabbit isn't eating normally (for whatever reason), the spurs will get worse faster as the teeth continue to grow but don't have the normal action of being worn down by chewing tough fibres in hay / grass. Quite often the first signs of a dental issue are that the rabbit stops eating a particular type of food (eg only pellets or only hay) as they find it painful to do that particular chewing action, and there is usually a small but consistent weight loss over a few weeks signalling that they are not eating enough.

I would look at getting the spurs burred down under general anaesthetic by a vet experienced in doing the procedure.

 

[Mara]

I know there is a possibility that the problem is dental. She has small spurs and mildly elongated teeth too. And she is only 1 year old, so it's concerning for her young age.
We have not addresses the dental issues yet because I'm from Canada, our exotics vets are expensive. The vet charges 300 dollars just for looking at the rabbit and talking to you. Any tests or procedures are additional cost, so every visit with a serious concern costs a thousand or more.

The vet told us that if the problem is dental, then it is certainly chronic; one trim will not fix the dental problem long-term, we would need to trim the teeth every 3 months or so. Considering how expensive it is, I don't think I can commit to that. If her problem is dental and chronic, we will sadly consider euthanasia.
He went with dysbiosis treatment because there is a possibility that this will help her, and she had weird looking droppings in the past. We want to try at least those treatments I can afford before giving up.

 

[bunny momma]

How is your bunny doing?

 

[Mara]

She is still very active and playful. However, no real progress with her appetite. A couple of days ago, we finished the antibiotic treatment. I still feed her a bit of Critical Care so she would not lose weight (18-20 g of powder per day). And I give her some probiotics.

Our vet is on vacation. After he returns, I plan to do some pictures/scans - and if no anatomical abnormalities are present, then I will try to trim her teeth. I want to do this at least once. Our vet told me that if her teeth cause her appetite loss, then one trim will not fix the problem permanently - but I guess I'm hoping for a miracle. I want to try this at least once. Also, I want to know for sure what is going on before making any big decisions.

The vet told me stress from other rabbits might cause appetite loss too, so I keep her 2/3 of the day separately from other rabbits to be sure she has enough time to relax and eat calmly. She likes company, so 1/3 of the day she spends with her rabbit friends.

 

[a reader of books]

I'm really sorry your bunny has been struggling with eating enough for so long now. It sounds like you're taking such good care of her. It must be stressful, not knowing what's going on.

Just want to say, as it might reassure you, that I've had several bunnies with teeth problems, and there really is no way your vet can know beforehand that if her problems are because of spurs, she will need a dental every three months or so, or that it's chronic before she's even had her first dental if the only thing he saw were some slight spurs and nothing more serious. I've had bunnies go years between dentals, and sometimes bunnies do only need one dental, if the teeth are otherwise okay (not misaligned) and the bunny is able to eat a diet after that that will keep her teeth in shape. From what I understand, if dental problems are genetic, the problems show up within the first few months; after that it's often because of diet or injuries or breed-typical problems, like in bunnies with flat faces. Is your bunny normally a good hay-eater?

Also, I was wondering if your bunny is bonded to the other bunnies? Do they normally live together and get along? Because if there's no issues, I would think keeping her away from her friends would actually increase her stress, rather than decrease it, especially since you say she likes company?

I'm sending so many vibes for your girl. I really hope you can find out what's causing her to not eat well.

 

[Moonstone]

My Millie had spurs filed down before her first birthday and hasn't needed to have it done again. She's 12. I suppose it depends what causes the spurs, I was told it was probably a poor diet from before she lived with me, a healthy diet seemed to fix it. Sending lots of positive vibes to your girl, it's great that she's still playful, long may that continue.

 

[bunny momma]

It is good to hear she is still active and playful even though her appetite remains low. Reader of Books and Moonstone are correct that dental issues may not be chronic. Though I have cared for two bunnies who did have chronic dental issues.
It is a good idea to continue with critical care to supplement her diet so she does not loose weight while you and your vet determine the reason for her poor appetite.

Sending positive vibes for your bunny.

 

[Mara]

Reader of Books, thank you! It's very reassuring to hear that it's possible. I felt hopless because my vet told in all his years of practice, only once he saw a bunny who has recovered just after one dental work - but this bunny had an abscess, so it was a completely different situation.

She is bonded with her parents; it's a trio. She is the biggest rabbit size-wise, but is a bit shy, tries to groom everybody and avoids fights. She gets along very well with her father and loves spending time with him, but her mother prefers the buck and often chases her daughter away from food, favourite resting places or even from the buck.
I try to find the balance how much alone-time is beneficial for her health.

I'm not sure whether she has a dental problem because I don't understand the logic of what food she rejects and why. Sometimes right after she rejects soft treats (apple, banana peel, cookie), she turns away and chews on hay instead. It's not how teeth problems usually present themselves!
And she is extremely interested in cardboard, tries to chew on it, but I don't let her do it.

Usually, I've given her hay cubes too... Since her teeth didn't look normal at the vet, yesterday I decided to limit her hay cubes and to offer her more hay instead. I want to test if that will change anything.

 

[Mara]

Her muzzle shape is healthy (long), she is Britannia Petite breed.
However, her father has a suspiciously "flat" muzzle... So, I spoke to the breeder and asked if they have ever mixed their Britannia Petite with dwarf breeds. Turns out, the breeder has done this and thinks that 30% of his herd carry a dwarf gene now.
So, there is a chance that she inherited some dwarf-associated health problems. However, considering that her muzzle looks long, and she is the biggest rabbit from all... I hope the real dwarfism has not affected her.

 

[a reader of books]

From what I understand, the problem isn't really the dwarf gene, but the flat shape of the face itself, as it means there's not enough room for a natural position of the teeth, which can lead to problems. So, if she has a nice long face, I don't think that would be an issue.

I'm sorry her mom often chases her away. Does it seem like it causes her stress?

Honestly, if I were in your situation, if I had a bunny who wasn't eating well and I know has dental spurs (tiny or not) and nothing obvious going on otherwise, I would absolutely go for the dental if she's in good enough condition. The only way you're going to know if it's dental or not is by having her have a dental and see if that fixes things. You can't always tell from outward signs, especially if your bunny hasn't had dental problems before and you don't have past experiences with them to look back on. My bunny Tom showed non-typical signs, too, as he would stop eating his greens, but would continue to eat his hay and pellets. It might be a different dental problem as well, like problems with her tooth roots or an infected or loose tooth or something stuck in her mouth somewhere, so I would ask to have them take an x-ray of her skull while she's having the dental, and for them to take a good look in her mouth, because she might just have a bigger spur or something else towards the back, which you can't see while the bunny is conscious. The way she's presenting, with not eating well but otherwise being active and well, is typical of dental problems, in my experience. With other health problems that would explain bad eating, the bunny is often quiet and more obviously unwell.

Bunnies who are really eager to eat cardboard are often looking for fibre. If she just wants to chew it, though, I'd let her. It won't harm her as long as she doesn't eat it.

 

[Mara]

Yes, pictures are a very good idea. I plan to do them because in the first month, I had strong suspicions that she might have the inner ear infection. That first month, often, she was holding one of her ears a bit weirdly... The ear was pressed to her head, only one ear up. That behaviour stopped after we started the antibiotic treatment, now she doesn't do this anymore, but I remember that I had concerns.
Inner ear infections usually cause weird sensations during chewing, and the rabbit might lose appetite. The pictures would help to see not only her teeth, but also if anything is going on with her ear.

 

[a reader of books]

You know, it's maybe not very scientific, but when it comes to bunnies I tend to go with my gut, so if yours is telling you there might be something going on with her ear it definitely sounds like a good idea to look into that. I hope you'll find an answer soon to what's going on with her. It's really unfortunate that your vet is on vacation right now.

 

[Mara]

Today, we have done dental and X-rays!
Her X-rays are normal... So it's still a mystery what is going on.
We went to a different vet; she is certified in exotics too. The vet warned me that the spurs on her teeth were tiny, it's unlikely that they were the reason for appetite loss, so it's not likely that the procedure will help, but I decided to do the dental anyway. Hoping for the best.
Her gums were very inflamed, the vet thinks it's from the prolonged feeding with Critical Care. (Problems first appeared in December, and since then, half of the time she was eating Critical Care).

This new vet has a slightly different approach than the first vet. She told my rabbit is extremely skittish, to a degree that she would even recommend giving her calming medications before the hospital visits. Skittishness is normal for Britannia Petite breed, but the vet thinks that even if it's common for the breed, this still should be addressed as a real issue.
She told me to look once more at the possibility that stress causes her appetite loss.

I will try to separate the does permanently - and let the buck spend the nights with his "wife", and at daytime he can have some playtime with his daughter. This way, they will be able to have nice playtime together, grooming each other, without the risk that the older doe attacks her and pulls her fur out.

 

[bunny momma]

Sending vibes the dental helps her situation.
You mention her gums are inflamed. Did vet prescribe any pain/anti inflammatory meds to address the inflammation and any discomfort it may be causing? Also, has she had any gut motility meds to speed up her gi system? If she has issues with her autonomic nervous system the system may not empty at a normal speed so she would not be hungry as often as another bunny.

 

[Mara]

They told me the inflammation causes some discomfort, but it's not severe enough to need medication.
I didn't ask for mobility drugs because last moth, she was on them for 2 weeks, and she needs a break now. Though they gave her one dosage of some meds during the visit (I paid for it but didn't ask what it was).

I don't worry about mobility drugs because my past experience with this animal hospital is that they are very 'generous' with medications; they almost overmedicate rabbits. If there exists different protocols of treatment in medical literature, they tend to go with the highest dosages and longest treatments.

 

[Mara]

Please help me to decide what to do next. I feel desperate. (My first rabbit is still alive , no changes, if anyone was worried).
However, I encountered a similar problem /disagreement with the vets from the same hospital.

My second rabbit suddenly stopped eating, I reacted fast and in 4 hours, he was already in the hospital. Because his temperature was low, they hospitalized him and put him in an incubator.
Here is the tricky part: they feed him their usual (very low) dosage of Critical Care and are stubborn in this. At first, I wasn't too worried because I hoped to get him home soon and feed him more at home. However, I can't take him home because even after a day of trying, they can't raise his temperature to a stable level (he loses temperature every time they get him out of the incubator). They want to keep him in the hospital for a second day.
He isn't eating or pooping. Blood tests are not ready yet.
I will ask next time if they use a syringe to feed him or a tube; my husband had the impression they use a tube.

Since they don't feed him properly, I think his chances of recovery are extremely low. I can't go to any other hospital because it is the only one that works on weekends. I can't take him home because I wouldn't be able to warm him up.
And I need to decide what to do next. I don't want to prolong his suffering. Also, I don't want to overpay for the hospital stay. Everything is expensive; every day at the hospital costs thousands of dollars. I'm thinking if euthanasia is a better option than keeping him in the hospital for multiple days without proper Critical Care feeding.
For now, I asked them to care for my rabbit until we receive his blood test results, but after that, I need to make the decision.
I love him so much... It's so ridiculous that they don't want to feed rabbits more. It's a simple task that could save a life.

What would you do in this situation? Thank you.