I lost my beautiful Netherland Dwarf this week with breathing problems/pneumonia. Advice needed

Question
QUESTION: Dear Dana
My much loved little Dwarf Rabbit Minnie was pts at the vets on Monday due to possibly having pneumonia. She was  being treated for a respiratory infection.
I first noticed something was wrong when my normally very feisty bunny became much calmer and was doing the occasional dry sneeze/cough. I initially thought this might be due to a hair ball or an allergy. The next thing was she started to have occasional bouts of mouth breathing with her head held high and fast breathing. This went away for a few days but then came back so I quickly took her to the vets. She listened to her chest (couldn't detect any noise) and took her temp. She said it was most likely a respiratory infection and prescribed a 7 day course  of Baytril (0.2ml twice a day). Minnie seemed to be improving, just having occasional bouts of mouth breathing but then appearing normal with head down and eating normallyat other times. Her appetite never went but she just seemed tired when eating sometimes. I decided to take her back on Monday as when I got up she had been perched on her food bowl at night with her head up and mouth open. It was dreadful to see. Just before we set off on the half hour journey she kind of rolled over on her side for a moment which frightened me.

The journey to the vets was a nightmare. I wish now I had changed vets and taken her to one 10 mins away as she kept rolling over in her little carrier and at one point I thought she had died :-(  

The vets rushed her into an oxygen tent and made an evaluation.  She thought she most likely had pnemonia and thought the kindest thing was to put her to sleep, which they did.

I have spend this week torturing myself on  where I went wrong. I was very puzzled as to why the breathing bouts were intermittant. Even on  the day she died she had 3 hours of grooming herself,  eating, head down although weary. Why would the bad breathing come and go?

She had no nasal discharge  just a bit of eye discharge. She was not as active and seemed uncomfortable when picked her up. She also kept diing a funny big yawn everytime I put her down in the hutch - was linked to the breathing?

I really regret having her pts as surely a culture could have been done and stronger abx tried intravenously but I was suffering seeing her struggling for breath, and decided to go with the vets advice.

The vet said that witb LRT infection  there are not always signs such as runny nose and rabbits can  succumb to Pneumonia very quickly.
.

Was the dry cough indicative of LRT.

I have had many rescue buns over the years and never see  this and want to learn from this so any advice would be appreciated so much.

I am puzzled also as to why a well kept and much loved housebun would get this.
Thanking you a nd sorry for the long post. Regards
Linda (U.K)

ANSWER: Dear Linda,

I am so sorry for your loss.  

The only thing I would ask here is:  Did anyone think to take a radiograph of her chest?

Open-mouth breathing is a sign of severe respiratory distress in a rabbit, as they are obligate nasal breathers.  If they cannot get enough air through the nose, they must gape for more.

There are several possiblities here:

1.  pneumonia
2.  bilateral sinus blockage (possibly due to advanced dental disease)
3.  thymoma

Of these, #1 and #3 could be determined via radiography (x ray).  A sinus blockage might be detectable with radiograph, but requires a vet who really knows how to read a rabbit head rad.

The saddest part is that none of these has a simple treatment, and if Minnie was in such a bad state that she was mouth breathing, she was going to suffer a lot during treatment that might not have helped her.

Pneumonia might not respond to antibiotics, but Baytril was a good first choice.  If she had no gurgling sounds in the lungs, then I have my doubts that it was pneumonia (though you can't always hear pneumonia if it's really severe, and the lungs are very clogged).  Nebulization with saline/acetylcysteine/aminophylline/amikacin might have helped if it was pneumonia.  But if it was this advanced, it might only have prolonged the inevitable.

If this was a thymoma (a tumor of the thymus that causes the thymus to enlarge and fill the chest cavity), then it might already have been too late to start radiation therapy, which can reduce the size of the tumor and help breathing.  But once the bunny is mouth-breathing, things are quite advanced, and treatment is not guaranteed to help in time.

The only way to know for sure what caused her breathing problems would be with necropsy, possibly including histopathology of her lungs.  

But I hope it gives you some comfort that I have seen a LOT of rabbits in this condition, and very few survive treatment once it comes to open-mouthed breathing.  Minnie was in distress, and although it was very hard for you, I think you did make the right decision, given all possible outcomes.

I am one of those who will not euthanize unless there is really no hope of recovery.  And I think if I had been standing in your shoes, I would have made the very same decision you did.  I know that doesn't bring her back, and it doesn't help the pain.  But I hope it will give you some peace to know that we're just mortals who try to cheat Death.  But in the end, he will always win.

I am glad Minnie had a wonderful life with you, even if it was too short.  

Sincerely,

Dana


---------- FOLLOW-UP ----------

QUESTION: Thank you so much Dana.

You have helped me immensely as I have been torturing myself this week thinking I didn't do everything possible for my little girl. I think what really bothered me was that she could have quite long periods in the day (4 hours or so) when she wasn't mouth breathing but just grooming and eating bits and pieces. This kept lulling me into a false sense of security regarding her health.  But, her  energy levels had definitely gone right down and the least bit of exertion or even being picked up could trigger a breathing crisis. Cuddling her could calm the breathing down but it always inevitably returned, particularly when alone at night when she probably started to feel anxious.

I think the thyoma is a possibility as her chest cavity did seem to give her some discomfort on being picked up although as you say, without xray this was difficult to determine.

The first time I took Minnie to the vets nearly 2 weeks ago, it was on a weekend and the vet hospital use an emergency service (why do things always get worse on the weekend). The vet was lovely but quite young and she didn't suggest an xray even though Minnie was mouth breathing. I suppose she thought the best thing was to get her straight on abx first and then see, which I suppose is quite rational. The mouth breathing was not as severe then. The second vet I saw on Monday would have liked to xray her but didn't see her surviving it due to the collapse in the car - just too much stress on an ill little bun.

If this ever happens again I will get a chest xray asap. Do they have to be sedated for that?

Once again, thank you so much for your reply Dana.It has really helped to lessen the pain that I let her down in some way.

At least we able to give Minnie nearly 3 years of loving care after finding her abandoned on a main road. I will just try to remember the special moments and that I did all I could.

I am sure this fantastic  advice  you gave me will help and give comfort to other rabbit lovers looking for answers on allexperts and the ww net.
Thanking you again
Warm Regards
Linda

Answer
Hi, Linda

The things you describe are consistent with thymoma, in my experience.  The bunnies I've had with this would not always show respiratory distress.  It seemed to be positional, perhaps when the mass shifted and pressed against the trachea or lungs more severely than in other positions.  That she seemed uncomfortable when her chest was compressed is further evidence that she might have had a mass.

Three year old bunnies usually don't develop thymomas, thought it's not unheard of.  But if she was adult when you found her, there's no telling how old she really was.  And as you say, her last three years were full of love and being spoiled.  You were there for her last breath. What greater gift could a true friend give?

Still sending healing thoughts,

Dana