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Mystery health issue

ruthsrabbits

New Kit
Hello,

So sorry this is going to be long but I could really use some advice, my rabbit Neil hasn’t been eating/drinking like his normal self for almost 2 months now, his poop quality and output is fluctuating but still not up to his normal. He’s a Dutch rabbit, unknown age but we’ve had him since 2023, he has access to a secure outdoor enclosure during the day, his usual diet was unlimited 1st cut Timothy hay, 1tsp of nuggets and dried/fresh forage 2x daily.


First week of May he had his vaccine, at this appointment our usual lovely vet saw some slight spurs on his teeth without any visible soft tissue damage, suggested since he’s not showing any signs of discomfort to watch and wait and book a dental later if necessary. She also thought she could feel a lump in his abdomen so advised us to bring him back in a weeks time for another check to see if it’s still there/changed etc.



At this second appointment (14th of May) no lump could be felt so we thought all was well. Following this he started eating less hay, pooping less, poops were smaller, harder and he started drinking less. At first I thought it could be from the stress of the vaccine and 2 vet visits in the past 2 weeks so gave him the usual potential stasis treatment of (additional to unlimited hay) dried and fresh forage and herbs every couple of hours, everything I offered he’d be really excited for and eat greedily except for his hay/water. He had a similar episode around the same time last year (unexplained stasis, slight spurs so did a dental just to be sure, similar long inconclusive stasis recovery where he’d only really eat and poop at night, but it didn’t go on as long as this episode) and we found syringe feeding him slightly warm (rabbit safe) peppermint tea helped with hydration and digestion so we started doing that again and also giving him a daily bowl of cool peppermint tea as he drinks this more consistently than water.



This went on for days so we took him to the vets where we met another (wonderful and amazing) vet who gave him a really thorough examination, she felt what she described as a lump in his stomach too but when she massaged his stomach it went away so she said it’s likely his caecum. When she examined his teeth she also saw the slight spurs and couldn’t see any sore areas, she took bloods that day and suggested depending on the blood results doing a dental just in case and maybe do some abdominal scans to be sure. So we booked that in for the 4th of June and took him home with metacam and cisapride, again he never lost his appetite for anything other than hay, even though he’s managed tougher foods than hay like dandelion roots, his poops neither improved or declined consistently, just fluctuated without any pattern.



His bloods came back, the lab tester told the vet his neutrophils/white cells were raised and that it could be indicative of e.cuniculi and the vet said we could pursue that after the dental if necessary but he doesn’t have any symptoms of it and it wasn’t brought up again post op so I’m not sure. His dental went well the vet showed us the X-rays, the spurs weren’t bad or causing any damage, his teeth aren’t misaligned but he has some bone density loss in his lower jaw (I think), particularly on his right side which might make chewing hay more painful, I was advised to feel his jaw regularly to check for any lumps/changes.



The vet said to continue metacam and cisapride for 5 days then try pausing pain meds to see if they’re necessary long term for his jaw, I gave him extra nuggets softened with peppermint tea instead of critical care since he would eat them well without having to stress him out syringe feeding him. We saw no real improvement or decline for a week, he slowly started eating more hay but only really in the evening/night, softer hay than his usual but I was grateful for anything, he seemed to be picking up for a few days with much better poops, no pain meds and less supplementary forage but since Saturday he’s dipped again so I restarted his pain meds, gave him another new type of soft cut Timothy hay, his poops have gotten smaller, harder and are more teardrop shaped.



Last night they were smaller still so I offered him some dried carrot tops, he ate some but much slower and didn’t look for the rest around his room, refused to be syringed peppermint tea, offered nuggets and he nibbled a few but normally he’d go crazy for them so I decided to take him to the OOH vet (not my usual vets) to get some medications to get his gut moving again. The vet could hear gut sounds, said his teeth look perfectly fine. She gave him 3 injections, buprenorphine, metaclopramide and one I can’t remember the name of that’s an appetite stimulant and helps with nausea even though rabbits can’t vomit. The bupe (I assume since it did this to my cat after her dental too) has made him spaced out and seems a bit confused. I’ve read that it can make rabbits stop eating well for a while and that seems to have happened since he’s even ignoring his favourites. He has thankfully ate some fresh greens from the garden this morning.



I’ve booked a phone consultation with my vet to see if we can come up with a plan on what to do/explore next but I literally don’t know where to start. I’m tempted to ask for full bloods and some full body scans just to rule out as much as possible as quickly as we can, I don’t want this to rumble on for more months if it doesn’t have to. It weirdly seems to follow after his vaccination both times, could he be reacting badly to that? I really hope not because it’s so vital and it might just be a coincidence but the timing is unusual!



During his stasis last year we were told he has an arthritic knee (not that you’d know from the way he jumps around haha) so could he have an issue with his bone health that’s causing pain in his jaw? Or anywhere else? I read that indoor rabbits that are fed poor diets can develop osteoporosis issues and he was rescued from horrific conditions so maybe his start to life could have led to this?



I’m just at my wits end and super sleep deprived after nearly 2 months of round the clock monitoring, 5 different types of hay, almost every possible leaf/herb, I even watch him on bunny cam while I’m at work haha. I just can’t seem to get him fully back on his feet, I’m desperate to figure out what’s going on so I can help him so if anyone has any ideas/advice what it could be or what I should ask the vet to check I’d really appreciate it!
 
My first thoughts would be to get xrays done of his abdomen to determine what the 'lump' could be, and to get the tooth spurs sorted at the same time. Head xrays may also be useful if there are issues with his jaw and teeth, and while he's already sedated.

Is there any reason why you can't start treatment for EC? It's usually a 28 day course of oral Panacur, which can be obtained without prescription. I use the 10% liquid version (usually listed as for cats & dogs) as it's easier to give an accurate dose and is cheaper than the paste in syringes.

What is his weight like? It's worth monitoring it weekly so that you have an idea about how much he needs to eat, as well as monitoring poo output.
 
I think you have done all you can to improve eating by adapting Neil's diet. I think if it were me, I would want to have some diagnostics done, mainly to exclude things. So I would support Shimmer's advice to have x-rays done of his abdomen and head, also sorting out the tooth spurs at the same time. I would also have another full blood count done, which will be interesting to compare with the previous one to monitor any change.
 
Thank you both so much, I’m definitely going to push for abdominal X-rays and full blood count, he’s had his head X-ray when he had his dental on the 4th of June, the vet was great she showed me it and talked me through it. She didn’t mention any arthritis of the jaw just bone loss at the tooth roots, I believe, which she said could be causing pain when he chews.


It’s just baffling that even on his bad days he can eat tougher things than hay but is still avoiding the hay? Even the softest cut of Timothy hay and meadow hay he barely touches, it’s so weird because he was such a good hay eater before this and he’ll have a few days where his hay eating picks up slightly, poops are softer, you can break them open and there’s hay in them but then he drops off again. And it’s so hard to get him to drink anything which I think isn’t helping his hard poops.


They didn’t mention the EC following his dental, not sure why but I’ll ask about it when the vet calls, thank you for the tip on the liquid version, that’s a life saver!

His weight has stayed exactly the same throughout this at 1.94kg, I’m going through so much forage so I think that’s keeping his weight up but I’m throwing away almost twice as much ‘used’ hay each week so I know he’s not eating it :(
 
When he had head x ray, did vet confirm he does not have elongated tooth roots or any middle ear infection? You mentioned his poop is hard. If he is not drinking enough, you may want to try giving some sub Q fluids (vet can instruct you) to hydrate gut contents. Also, has the vet checked for impaction in his cecum? Some gut motility meds work on the stomach and another works on hind gut. Sometimes both are used together.
Sending positive vibes for you.
 
The area of concern she showed us on the X-ray was mostly his lower right jaw (I so wish I could have recorded the conversation or made notes - I definitely will next time!) I can’t remember the exact phrasing but there was a focus on the root of the teeth likely causing nerve pain when he’s chewing which is why she wanted to try and see if taking him off pain meds made a difference. She didn’t mention anything about his ears but I’ll ask the vet tomorrow when she calls to look on the X-rays again to double check, thank you for bringing this up I’m compiling a list of things to ask about pursuing so this is so so helpful!

I had no idea we could do sub Q fluids, I’d definitely be interested in that since he’s just letting any water fall out of his mouth when I try and syringe him. He’s had some wet foraged herbs/carrot tops and strawberry leaves from the garden but hasn’t had a drink independently at all today. I’m not sure how much of this inappetence is from whatever’s going on with him vs the buprenorphine.

I don’t think they checked for impaction in his caecum, do you know which gut motility meds are better for that so I can request them tomorrow?

Thank you so much again for your advice and positive vibes!
 
The area of concern she showed us on the X-ray was mostly his lower right jaw (I so wish I could have recorded the conversation or made notes - I definitely will next time!) I can’t remember the exact phrasing but there was a focus on the root of the teeth likely causing nerve pain when he’s chewing which is why she wanted to try and see if taking him off pain meds made a difference. She didn’t mention anything about his ears but I’ll ask the vet tomorrow when she calls to look on the X-rays again to double check, thank you for bringing this up I’m compiling a list of things to ask about pursuing so this is so so helpful!

I had no idea we could do sub Q fluids, I’d definitely be interested in that since he’s just letting any water fall out of his mouth when I try and syringe him. He’s had some wet foraged herbs/carrot tops and strawberry leaves from the garden but hasn’t had a drink independently at all today. I’m not sure how much of this inappetence is from whatever’s going on with him vs the buprenorphine.

I don’t think they checked for impaction in his caecum, do you know which gut motility meds are better for that so I can request them tomorrow?

Thank you so much again for your advice and positive vibes!
You vet should be able to tell you the gut med that is better for hind gut vs stomach issues. My vet prescribes both metacloprimide and Cisapride for stasis.

One of my bunnies could not get buprenorpgine when he had dentals because it made him very lethargic for longer than usually expected. Also, the bunny's mouth may feel different after a dental or ache a bit from being held open during the dental, It may take a few days before a bunny eats normally.

You mention your bunny eats harder items than hay, yet refuses even softer hay. Did you know that eating hay requires a different chewing motion (more side to side) than eating nuggets (more up and down). If a bunny has small spurs on teeth, the spurs may rub the soft tissue when eating hay, yet not when eating nuggets because of the different motion. So I am glad your bunny had a dental.

Sub Q fluids can be done at home and I always have the fluids and supplies available. Though they take time to absorb, so not as effective as iv fluids in a very sick bunny.

Please know, I am suggesting things based on my personal experience as a bunny parent. Your vet will be your best source for medical knowledge.

Sending more vibes for your vet appointment.
 
Thank you so much for replying again and for the vibes! He’s seen another new vet today and been admitted for fluids, pain management and syringe feeding. He’s got spurs starting again on his teeth and some ulceration in his mouth which was missed by the OOH vet so he’s going to need another dental poor little guy. At least it explains why he stopped eating even the soft snacks on Monday evening.

I’m hoping the dental will be done by our usual vet so I can ask her to get some other tests done at the same time, full bloods, abdominal scans and to ask again about whether we should treat him for EC. I’m not sure if his issues are 100% purely dental or if there’s something else making him feel poorly/in pain which is making the dental issues more pronounced since he’s previously gone a year between dentals? Or is it just bad luck/dental issue progression to go suddenly from one year to two weeks between dentals?

Thank you for the info on the gut meds, I think maybe he needs additional pain medication and both types of gut stimulant medication following his next dental since I don’t think he had enough for him to kickstart him into eating properly after this recent one on the 4th of June.
 
Neil’s home from the vets, his metacam dose has been upped slightly and he’s been given metaclopramide too, our usual vet who did his dental on the 4th has checked his teeth and she thinks he doesn’t need another one yet, I’m interested to talk to her more about this when I see her at his follow up appointment on Monday since she was in the practice today but not seeing clients.

She’s also said she’d like to start him on the E.cuniculi treatment from Monday (I presume) so I’ve gone ahead and ordered the liquid version of Panacur in anticipation, thank you so much again for the heads up on that, everyone’s experience/advice has been so invaluable to me so thank you all so so so much again!!! 💕
 
Neil’s had another vet visit with our usual wonderful vet Claire, he’s still not eating on his own and fighting hard against the syringe feeds so we’ve started his panacur treatment to see if it helps in any way and he’s being referred to a vet called Rieke Hettrick who is really rabbit savvy and will hopefully help us get to the bottom of what’s going on with his weird intermittent stomach lump/whatever else could be causing this stasis.
 
I am sorry I did not see your update until today. How is your bunny? Did you get to see the rabbit savvy vet? Sending more vibes.
He’s doing a lot better at the moment, the special rabbit vet was absolutely lovely, he’s booked in with her on the 16th for a CT scan with and without contrast, another check of his teeth (and dental if necessary) since she could see some irritation in his cheek as if he’d been biting on it but nothing on his teeth seemed to be causing it but of course it’s hard to see well with a conscious rabbit.

While we’ve been waiting for the scan appointment he’s continued the liquid panacur treatment, she’s upped his metacam dose and prescribed paracetamol and gabapentin to have twice daily. I’ve tried to space them out evenly throughout the day and night to be sure his pain is as controlled as possible, he’s back to his usual self so far now that he’s on more pain relief so hopefully the CT will give us some insight into what’s causing him pain!

Thank you again for the advice and good vibes, Neil and I are very grateful for the support and ideas!
 
Proper pain management can make a huge difference in a rabbit. I think it is a good idea to spread out the doses as best you can.
I am glad to read Neil is eating well with the increase in pain meds and I am sending positive vibes that he does well with his scans/dental and you get a diagnosis and treatment pla.n for Neil.
 
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