Resistant Pseudomonas found, clinically better but been told palliative care?

[~ILoveMyBunny~]

Hi again all, really need some support/advice. I'm in a bit of a daze, feels like being hit with a truck with the news we had today.
I posted a little while ago about our 11yr old boy who had/has a horrific lower respiratory tract infection (previous thread: https://forums.rabbitrehome.org.uk/...tion-pneumonia-copd-any-advice-at-all.490914/)
He has been battling it for a few months and its hit hard. It turned to pneumonia and he was in an awful state. Last wednesday I got him in urgently as he was mouth breathing and sucking in so much air (some had been visible on the xray done about a week before) and so congested he was struggling to breathe. He had so much mucus he had trouble clearing it. He was seriously, seriously ill. We'd done a second swab (previous didn't show anything relevant) on that day, the results of which I got today.

On Friday evening we were fully convinced we were losing him as he became very severely sick, honestly I didn't think he'd even make the journey to the out of hours vet. He couldn't breathe and went limp in my arms. We genuinely thought any second would be his last breath and given the last time we had a bun with breathing difficulties she passed in the taxi long before we arrived we decided it would be kinder to let him pass in our arms safe at home rather than put him through stress for his last moments. There was no doubt in my mind he was at the very end and wouldn't make the journey. So we stayed, we held him and we waited.
3hrs went by in the end. Then suddenly out of nowhere he shot up out of my arms, stood and sneezed several times. Then.. Nothing. No more congestion. No mucus. No severely laboured breathing. No collapse. He was standing on his own, breathing pretty well considering. A few moments later he ran over and started madly eating herbs. In 23yrs of having rabbits I had never seen anything like it. To be at deaths door one moment then hungry and breathing better the next, it was so weird.

In the days following he's gone from strength to strength. Slowly he's eating more, he's looking more comfortable, he's breathing almost normal a lot of the time. There's no congestion, no mucus. Where he'd been having sneezing fits with wet mucus before he now has maybe 1-2 sneezes at most in a day and they are dry and easy to recover from. His energy levels are going up, he's exploring more and interacting with his environment more. On the wednesday we'd changed from co-trim to ciprofloxacin so I assumed it must be working.

I took him in for a recheck today as I had seen what I was worried was blood (turned out not to be thankfully) in his urine and I thought he had a mild head tilt.
It seems it was pigment, no blood was found in the urine and the tilt doesn't appear to be so pronounced today. He's had an exam and the vet is happy that it doesn't seem to be a problem, she thought maybe it was just mild discomfort from his sinuses. Not sure myself but I'll monitor that.

Here's where everything came crashing down. I was told the results had come back and unfortunately they were showing a highly resistant strain of pseudomonas. She said it was resistant to everything and there's nothing that can be done. It can't be fixed, all we can do is provide palliative care.
This was such a shocking blow because since Friday we've seen him get better and better, I honestly thought we were on the right path.
She said we could use an injectible or nebulising antibiotic (I think it was amikacin) but that it is a really brutal one that is really rough for them. She's given the option to try it in the nebuliser or not. I honestly didn't know what to do but the fact that he seems "stable" at the moment makes me think maybe it's not good to risk upsetting the balance we have if he's doing better but this thing could make him considerably worse? I can call in if we change our mind and want to try it.

I'm just so confused by everything here. Clinically he's showing massive, dramatic improvements but the culture results have given him a death sentance. I just don't understand? Even if it is the case that he has two bacteria and the ciprofloxacin is fighting off the other one, if the pseudomonas is so severe that it will end his life how is it even possible for him to get better at all? He was on the brink of death Friday. How could he survive through that if this thing is killing him?
Everything I've read up on since getting home suggests that it's one of the hardest to treat, but nothing says its an outright death sentance. Unless it's just because it's a very resistant strain. But even so, how could he have gotten any better with that thing present?
I've been told there's nothing that can be done, just palliative care. She has no idea how long he has left, not even a vague ballpark. I don't know if he could have weeks, months or just days. Or years. I just don't get it.

I'm sorry for the long thread, I'm just in a complete daze at the moment and I can't understand it, it makes no sense.
I am concerned as she suggested getting gloves due to it being contagious and dangerous as a resistant strain. He is not bonded with our others sadly but although we've been taking precautions with the others not to pass anything to them we have not been taking any ourselves. We've been hugging and kissing him and nothing has happened; my brother is immunocompromised too. We didn't even think of it being zoonotic, I'm used to most things with rabbits not being a problem to humans so neber even considered it.
I'm just so confused and dazed at the moment. We had finally had hope with his dramatic improvement Friday. Now it's all been dashed.
Has anyone had any experience with this? Any advice at all?

 

[Shimmer]

I would just take it a day at a time. Keep doing what you are doing. As long as he's happy, he doesn't see it as a problem.

I'm in favour of nebulising in general, as long as the animal will tolerate being in an enclosed box or carrier while it's carried out. There's no point in stressing them out even more if they really don't like it. It also helps to get drugs deeper into the lungs, but you can use just saline to help with the breathing.

 

[joey&boo]

How strange, the episode he had before everything rapidly started to look a lot better. I can see why the vets prognosis is upsetting, especially in the context of how he has been presenting so much better. Did a lot of mucus come out? I've no medical experience or knowledge regarding your / your brothers bun but I do feel how they present & look is more important than what the tests say. I'd try and enjoy every day with him

 

[Zoobec]

I don’t have any experience of this, so I can’t give advice, but I’m sending vibes and hugs xx

 

[William]

Wow, I can see why you're confused. That must've been crushing to hear the bad news after almost losing him and then seeing him getting better and better.

I've never even heard of pseudomonas before, and also wouldnt have thought about zoonotic illnesses since it's not uncommon for rabbits to get standard respiratory illnesses.

The only thing i can think is maybe on Friday he was having a stroke or heart attack and recovered from it? But I don't know how likely that would be, especially considering the pseudomonas prognosis.

And it doesn't explain why he's also been getting better since then..unless his body is actually fighting it all by itself without even antibiotics? Again, not sure how likely that would be since it sounds like a very aggressive, resistance strain...

I'd do like Shimmer said and take it a day at a time and go from there. And I'd be super careful about contamination as well, for humans and rabbits.

Regarding a possible stroke/heart attack: I actually experienced something kind of similar in July with my 20 year cockatiel. He suddenly collapsed, was breathing fast with his wings spread out while lying on the cage floor and acting like he was dying. I thought for sure he was. I decided not to stress him, just mostly leave him alone (on the very slim chance he could recover), but I went over often and spoke softly to him so he'd know we were there. After a few hours he started looking better and I had real hope. Within 24 hours he was normal, eating and drinking. I'd never see anything like that - I thought he was dying of old age.

It might be a good idea to look into other things that can cause breathing episodes like what happened with him almost dying on Friday. In case it helps any. For example, my duck had a respiratory illness that wasn't a problem in itself (he was recovering fine from it) but it triggered what I believe were laryngospasms which left him suddenly unable to breathe. Then all the sudden he'd be fine again.

 

[~ILoveMyBunny~]

I would just take it a day at a time. Keep doing what you are doing. As long as he's happy, he doesn't see it as a problem.

I'm in favour of nebulising in general, as long as the animal will tolerate being in an enclosed box or carrier while it's carried out. There's no point in stressing them out even more if they really don't like it. It also helps to get drugs deeper into the lungs, but you can use just saline to help with the breathing.

He had been on F10, Salbutamol and when needed saline. Thankfully he tolerates it extremely well. I had another bun who I lost 2yrs ago who had a respiratory infection and, unfortunately we later discovered, thymoma that had spread to her lungs. She was much more difficult to nebulise but Pinot is extremely tolerant - he even seemed to enjoy it at points, I feel like he knew it was helping him when he was really bad.
The strange thing is it's like 95% of the problem evaporated overnight on Friday. His breathing most of the time is now only slightly more laboured than a healthy bunny. He's been more active each day and though I expected today to take quite a toll on him (vet is 45 mins away so long journey) it doesn't seem to have hit him as hard as I expected.
I did suspend the nebulising temporarily as I wasn't sure if it made him a bit worse on Friday/Saturday but the vet would like him to be on the F10 again so we did one after we got home and will resume twice daily on that. I'm not sure he needs the salbutamol but we have it on hand if we do + a big bag of saline.
I still don't know whether to try the amikacin or not but I'm edging towards not because he seems as "stable" as he can at the moment and I'm worried about rocking the boat too much.

 

[~ILoveMyBunny~]

How strange, the episode he had before everything rapidly started to look a lot better. I can see why the vets prognosis is upsetting, especially in the context of how he has been presenting so much better. Did a lot of mucus come out? I've no medical experience or knowledge regarding your / your brothers bun but I do feel how they present & look is more important than what the tests say. I'd try and enjoy every day with him

Strangely no, it didn't seem to be a large amount. That's what confused us when it seemed he was so suddenly considerably better after.. whatever it was that happened.
It's honestly shattering to have had this news today, it might have been one thing if he was still bad but I honestly thought he was on the right track and had a good chance at recovering. Prior to this infection he had been extremely healthy aside from chronic eye ulcers. But he was still running, binkying, playing, no signs of arthritis. We thought he would have several more years in him, I really thought he would make a really old age. He just seemed so healthy. This is still so confusing and devastating to process because he just seems so much better. I don't understand any of it and the more I try to make sense the more confused I am. Reading up on it tonight it looks like its incredibly difficult to treat but I haven't seen anything that says it's a death sentance.
We lost our 10yr old nethie in April so it's even more devastating. He was only having an x-ray prior to a dental when his heart stopped. They got it going again but he only survived another 6 days.
I am trying to take that outlook and trying to encourage my brother to do so too, but we've had him so long through our parents divorce, our Mum's cancer and death, he's been with us through so much. It's the fact that he seemed to be getting better that's making it so much harder.

 

[~ILoveMyBunny~]

I don’t have any experience of this, so I can’t give advice, but I’m sending vibes and hugs xx

thank you xx

 

[Cinnabun14]

I'm so sorry. I don't have any experience to help, but I'm sending big vibes and hugs your way

 

[~ILoveMyBunny~]

Wow, I can see why you're confused. That must've been crushing to hear the bad news after almost losing him and then seeing him getting better and better.

I've never even heard of pseudomonas before, and also wouldnt have thought about zoonotic illnesses since it's not uncommon for rabbits to get standard respiratory illnesses.

The only thing i can think is maybe on Friday he was having a stroke or heart attack and recovered from it? But I don't know how likely that would be, especially considering the pseudomonas prognosis.

And it doesn't explain why he's also been getting better since then..unless his body is actually fighting it all by itself without even antibiotics? Again, not sure how likely that would be since it sounds like a very aggressive, resistance strain...

I'd do like Shimmer said and take it a day at a time and go from there. And I'd be super careful about contamination as well, for humans and rabbits.

Regarding a possible stroke/heart attack: I actually experienced something kind of similar in July with my 20 year cockatiel. He suddenly collapsed, was breathing fast with his wings spread out while lying on the cage floor and acting like he was dying. I thought for sure he was. I decided not to stress him, just mostly leave him alone (on the very slim chance he could recover), but I went over often and spoke softly to him so he'd know we were there. After a few hours he started looking better and I had real hope. Within 24 hours he was normal, eating and drinking. I'd never see anything like that - I thought he was dying of old age.

It might be a good idea to look into other things that can cause breathing episodes like what happened with him almost dying on Friday. In case it helps any. For example, my duck had a respiratory illness that wasn't a problem in itself (he was recovering fine from it) but it triggered what I believe were laryngospasms which left him suddenly unable to breathe. Then all the sudden he'd be fine again.

Honestly that's what's making it so much more crushing - we feared thymoma for a while but got the x-ray done and ruled it out. That was a relief. Then for him to start improving so well after ciprofloxacin we started to have hope that he could beat this. It's having had that hope and relief only to hear this that's making it so hard to process.

I have no idea if it can, the vet says it can't be fixed so I assume his body can't fight it off. But maybe he had a second bacterial infection (which may have been the primary one) which is sensitive to ciprofloxacin and the pseudomonas was opportunistic and developed on top? Kind of like how EC can lay dormant until the immune system is stressed by something else? I don't know, it's a purely uneducated guess. But then if the pseudomonas is so severe how is it even possible for him to have recovered so well?
Thinking about it he also had a brief stint on steroids. That didn't seem to send him down at the time but maybe it allowed the pseudomonas to take a hold. Argh I just don't know.

I'm not sure about stroke or heart attack. I've unfortunately witnessed what I believe to be both, this didn't look like that to me. I had my hand under his chest the whole time and his heart was incredibly fast but strong. But he just couldn't breathe whatever we tried to do to help. He went limp at one point and couldn't stand, I think he was starting to turn cyanotic but throughout his heart stayed strong.
That said, if he has a very very minor head tilt perhaps he could have had a small stroke? I don't know. Though again, that seems to have mostly righted itself today. Goodness it's so hard to make sense of.
I'm so sorry you went through that with your cockatiel. That must have been so painful and distressing. I had a bun who I lost at only 6yrs old very suddenly and I think she had either a heart attack or a stroke. She died in a very distressing way whilst waiting for a taxi to get me to the vet. I can never shake the memory of that, it's the most painful out of all the buns we've lost because of how awful it was.

 

[~ILoveMyBunny~]

I'm so sorry. I don't have any experience to help, but I'm sending big vibes and hugs your way

thank you xx

 

[bunny momma]

That must have been very scary. He may have been in pain or going into shock when he was fast breathing and getting limp.
You are seeing improvement in his breathing and behavior so something is clearly helping him. I would be reluctant to take him off the current antibiotic. Would the nebulized antibiotic be in addition to the current one? Is the new antibiotic one that is may disrupt the flora in his gi system?
Sending vibes for you, your brother, and your bunny.