One Rabbit, Multiple Issues, Several Vets, Time Sensitive, What to Do?

Question
QUESTION: Hello Dr. Krempels,

I have a soon to be 9 year old lop rabbit who is currently having problems with her ears, among other things. I am at my wits end and don't know what I should do for her...I apologize in advance for the lengthiness of my post. My Cuddles means the world to me and I just want to be as thorough as possible for her sake. I have read many of your articles and consider you to be the Dr. House of rabbits -which is why I'm beyond grateful you are accessible to bunny parents like me.

To begin with, for the last several years, Cuddles has had issues with "poopy butt" which I believe is the result of excess cecals. She gets a few romaine leaves, a tiny slice of carrot, 1/2 leaf of kale, and either a few sprigs of parsley, cilantro, or dandelion, divided throughout the day. My vet told me I was most likely feeding her too many vegetables, especially (any) carrot, but despite cutting out vegetables it has made little, if any difference. Suffice it to say she is accustomed to "butt baths" when it's bad, where I hold her along one arm and clean her with my free hand under running lukewarm water (so only her genital area and tail gets wet, in which case I gently dry her with a soft microfiber towel). Otherwise, I just take a damp paper towel and wipe some of the clumps off. Interestingly enough, I noticed when she was on antibiotics, she had no "poopy butt" whatsoever, but the moment she's off them, it immediately returns. Cuddles eats tons of timothy, either 2nd or 3rd cut. Could this be the reason behind her excess cecals? She won't eat the high fiber 1st cut anymore or else I might have a better idea. While she's nowhere near as active as she was a few years ago, from my observations she can reach her butt just fine, so I don't know if it could be arthritis. Also, recent x-rays didn't show out of the ordinary teeth problems like spurs, so I don't think it's dental related necessarily. Cuddles is on Oxbow digestive support tabs and Benebac for "poopy butt," but so far nothing is really touching it other than antibiotics. I would rather address the root cause and not treat with antibiotics if possible. I trimmed a bit of her fur around her lower abdomen and tail that was constantly getting matted with cecals, which seems to have helped. On a side note, she has been eating her "regular" poops daily and leaving some of her cecals alone. Should I be concerned she's eating those poops as frequently as she does? I am extremely hesitant to remove all veggies for longer than a week like I did when experimenting with her diet because she drinks little to no water (ever since her emergency spay/ovariohysterectomy a few years prior). The vet told me this is likely due from getting all the water she needs from the washed, soaking-wet vegetables she eats, and is nothing to be alarmed about since she's well hydrated.

Cuddles had an visible anal polyp that has been slowly growing over the last year or so (about the size of an eraser on a standard pencil). I was told by my local exotic vet that the best course would to let it be unless it grows more. Fast forward to about 6 weeks ago I returned from a week long absence and noticed her ears were hot and a little red on the inside of one like she had been scratching. My mom was taking care of her and didn't notice any behavior out of the ordinary. (Last year around the same time she had a nasty ear infection. I believe when she had this issue last year she was either put on oral Baytril or sulfatrim, possibly Cipro. One side of her face still looks droopy or excessively swollen compared to the other and it never went away; I've been researching Horner's Syndrome as a DDX). Then a few days later I noticed Cuddles was (uncharacteristically) intensively preoccupied with cleaning herself down there. When I examined her I noticed blood on the floor and around her anus. Not knowing what to do I gently blotted her with a damp paper towel, then a dry one, and applied regular Neosporin. Shortly thereafter I noticed her teeth were making a squeaky sound when eating timothy, almost like the sound of running you finger across a wet glass or mirror. On a side note, 6 months ago also I noticed her snoring while sleeping, which I never heard her do before, but was assured by my vet that bunnies in fact can snore, and wasn't necessarily something sinister, especially for older, larger breeds. Because of the litany of things that needed addressing ASAP (I am moving cross country via plane for grad school with Cuddles and her once bonded partner), I took her to a exceptionally savvy exotic vet over an hour away that she saw years ago for an emergency spay since she was urinating actual blood (not simply darker and redder than normal). This time, the vet found pus in both her ears and diagnosed it as an ear infection and looked at it under a microscope (if I recall correctly) along with taking a blood sample, but not a CBC. For her ears, she was prescribed chloramphenicol, Baytril,  Nolvasan Otic, and Metacam. The teeth they could reach were filed because some were "side-stepping."

After roughly 10 days of no improvement, I noticed her teeth were making an even louder squeaking sound and with certain food, it sounded as if she was chewing rocks, in addition to developing an abscesses-like bulb at the base of one ear. It was during this time, while giving Cuddles her Oxbow tab, I noticed she could not chew/bite hard food like she used to. Instead she would stiff it, look at me and wander off. However, if that same tab has been soaked and allowed to soften, she gobbles it up earnestly. This is particular made me worry if it could be a spur, infected root, or just dental disease in one form or another. Earlier, I spoke with the vet about a surgical flushing he mentioned at the prior appointment, so she was scheduled for that, along with removal of an anal polyp, a very close examination of her teeth, mouth, and more thorough filing of her molars. The Dr. also explained it was not an abscess in her ear, but rather the collection of puss that was unable to drain and a surgical flushing was really the only way to remedy that. Before surgery (3 weeks ago), I insisted on a CBC and X-ray of head and body, which didn't reveal much unfortunately. Interpreting the radiograph, the vet noted her throat or upper airway had shifted slightly, and that could account for the snoring. (Her snoring is not just limited to sleeping now, but when she rests her head stretched out flat on the floor, or when I give her a massage). The X-rays didn't show anything definitive like a cranial tumor, infected tooth root, etc., but interpreting the tests, she looked otherwise healthy, so Cuddles had the surgery and all went well.

Her polyp is now gone, teeth have been filed to where she longer makes a weird or unsettling sound while chewing, and that bulb/collection of pus was gone -but now, it's back. I believe she is in discomfort because of her increased respiratory rate and third eyelids showing-which is very uncharacteristic of Cuddles. The vet gave me a refill on meds with an additional Gentamicin combo otic, but I'm wondering if she should have been on them much longer (she had her final dose of Baytil last weekend, chloramphenicol a few days before that, and Gentamicin drops today). Now it appears the only way to remove the pus is to have yet another surgical flushing, but it would most likely return, as the vet cautioned me. From what I have read online antibiotics will help with the infection, but it won't do anything to drain the clogged pus in her ear. Before the surgical flushing, I authorized ear resecting if he thought it was necessary, but since he was able to reach her ears to flush them about 15 times each and remove all the debris in her ear, he didn't think it was needed (but the sides of her head were shaved in case it came to that). Do you think Cuddles' best option would be to have her ears resected? Should it be done ASAP or by another rabbit savvy vet where I'm moving to? I want what is best for her, no matter the cost or maintenance/care commitment from me.

In case any additional info helps:

-The bond between Cuddles and her partner broke roughly 6 months ago and Cuddles has been relocated to my room. They get along well while kenneled (e.g. a trip to the vet) or even while walking around the same room at the vet. No amount of marriage counseling helped (e.g. frequent car rides for bonding, vanilla scent on top of head, petting them together while they face each other etc.).

-Cuddles' former partner has been diagnosed with Pasteurella and is on and off antibiotics every few months, unfortunately she still sneezes constantly and in rapid succession. Sometimes it's so bad pus or other gunk sticks to her nose. When the wood stove pellets (accelerant-free) I use as bedding turns powdery, that can trigger a sneeze attack.

-Cuddles suffered from sore hocks about 4 months ago. I figured that could be the culprit behind not running around the house anymore. I treated with regular Neosporin at first, then switched to placing soaked black tea bags against her bony and red feet for 10-15 minutes each night, for 2 weeks. This helped immensely, and her feet now look calloused, white and a bit flakey -no sores, no redness. Unfortunately she still doesn't run around the house like she once did, but I have a bag full of her loose fur to stuff in a makeshift boot just in case it returns.

-While trimming her nails a few months ago, I noticed her cuticle was bright red and swollen on a few of her toes. She is great about letting me handle her for nail trimmings, but when I touched those certain nails, she heavily resisted and kicked. Even the area under her nail was extremely red. Then I decided to take a closer look at each nail; a few were all white and could bend in any direction, despite Cuddles flexing her toes and claws forward, the white ones stayed limp. Could a few of her toes be broken or dislocated? The rabbit savvy vet told me either way, there's not much that can be done other than give her Metacam. Between the sore hocks and possibly broken or dislocated toes, could this be the reason Cuddles does not want to walk around the house? Is this because she walks on blankets on top of carpeting or rugs in my room now? Prior to the bond between her parter being broken, she was on wire flooring for half the day and carpeting the rest.

-Also, from time to time I notice Cuddles has an incredible amount of flakes (dander I presume) around her bottom roll of rump fur and on the back of her ears. I don't know if that's from grooming her or getting her slightly wet in that area. The vet didn't seem concerned and attributed it to old age.

-After the surgical flushing, Cuddles' shoulders have been getting redder. Her hair is matted together in clumps, and it feels oily almost. The vet told me it could be from the ear medicine getting on her when she shakes it out (even though I am very careful and wipe the inside of her ears with a damp cloth afterward). He said I could use Dawn and the vet tech mentioned hydrogen peroxide, but I am hesitant to use either of those as it is already inflamed, could I use baby cornstarch or a specific, all natural, shampoo I could use. I don't know of any specific brands or products I should use.

I'm so worried that her ear infection is going to spread to her brain, bone, and/or cause vestibular problems. I recently lost my lionhead rabbit from an ear infection that caused head tilt and a nystagmus -to the point where even with Critical Care and meds, he wasted away until we decided his quality of life was not sustainable, despite our best efforts. Could everything be related and Cuddles has an underlying condition that would account for all the symptoms and issues she is displaying? I've spent well over 5k on procedures, medicine, vet visits on just her...I don't know what else to do. I leave for grad school in just over 2 weeks and can't put her through the stress of a plane ride if it can cause her condition to worsen. She hasn't done a binky in over a year and just want her to be happy and healthy. If you would like copies of any of her radiographs, ultrasound from a few years ago, CBC, culture from last year, smear results, exact weight, medicine history, pictures of her face, ears, or body, video of her breathing noise, I will get them for you.

I know this post is a bit segmented and choppy, it was difficult to make it as reader friendly as possible, my apologizes. Many thanks in advance for any advice.

Sincerely,

Jillian

ANSWER: Dear Jillian,

I will try my best to answer your question, which I *think* is:  "Should I have the ear resection done?"  But to get the best results from this service, PLEASE don't write such a huge history.  I can better answer your question if you send separate messages, each with a pertinent section of this extensive history.

To answer the question you have posed here:

YES, I would have the masupialization done.  This will allow more air into the ear, helping to prevent these infections, which are common in lop rabbits with their abnormal ear canal anatomy.

No surgery is 100% risk free.  But the stress of continued treatments (some of them surgical) to dig the infection out of her ear will eventually cause problems.  So if this were my rabbit, I would opt for the marsupialization of the upper ear canal.  Note that I would NOT, at this time, recommend a complete ear canal ablation.  Just opening the upper area, where the abscess is now forming (yes, the hard lump at the base of the ear IS an abscess) might help resolve the problem, and at least allow access for ear flushings, as necessary.

I hope this helps.

There are several places where I'd like to make comments above, but wanted to get this to you ASAP.  The AllExperts site has been acting up, and not allowing me to send.  So I hope this gets to you.

Dana

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

QUESTION: Hi Dr. Krempels,

Thank you for quickly sending me your thoughts on Cuddles' best options. You're right, now that I'm re-reading my letter, I should have wrote much less. It was inconsiderate of your time and kindness; I apologize (this is my first time using allexperts.com or any online feedback forum for that matter and I will be sure to do my best to keep it simple).

A quick update: I flushed Cuddles' ears an extra time last night with the Nolvasan Otic after smelling an overwhelmingly foul odor emanating from one of her ears. Upon flushing her ears, a 1-inch long, fairly narrow piece of debris dislodged from her left ear. Please pardon the following graphic description; a dime-sized chunk of pus with the consistency and likeness of raw chicken fat was wrapped around a firm ball of a light brown substance (I believe it was ear wax) was irrigated from her right ear. This morning I noticed a new abscess is starting to form in the base of her right ear.

Per your recommendation (and my own limited understanding of available research), I will schedule Cuddles for marsupialization of her ear canal -NOT the total ear canal ablation. I completely concur that the benefits of this procedure outweigh the risks and at this time, it appears to be the best course of action (the latter surgery frightens me as it looks to be a bit too drastic, risky, and possibly unnecessary in her case). In your opinion, should/can both ears be partially resected simultaneously?

My bunny savvy vet only performs non-emergency surgery on Thursdays, and unfortunately can't get her in until this Friday or Monday at the earliest (with emergency surgery fee accessed, but will not hesitate to do if recommended). I am scheduled to fly cross country with her, (non-stop, roughly 4 1/2 hours flight of time) next Thursday. Do you think she should have the resecting done ASAP here, or after the flight in our new, relocated-to city? I have already found another highly rated, rabbit savvy vet that my current vet just so happens to know, so I am hoping my girl would be in goods hands should that be considered an option. When I spoke with vet about rabbits and travel, he informed me as long as the cabin is pressurized, she SHOULD be fine in regards to her ear infections (stating rabbits can handle pressure much better/differently than humans because of the anatomy of their ear).

I understand you plan on replying to the earlier content I posted in my initial inquiry and will refrain from asking additional other questions in the interim.

Thanks again.

Regards,

Jillian

Answer
Dear Jillian,

Tough to know whether to do the marsupialization before or after travel.  You probably don't want her recovering from surgery if she's going to be airborne and in a stressful, strange situation.  I would think that trying to flush her ears *very* well before traveling might be the best option, as this will help keep the ear canals open for whatever pressure changes she might be subject to during the flight.

And don't worry about graphic descriptions of goo.  Believe me, I've seen things you would not want to imagine!  8P

As for answering the rest of the questions in your first email...I'm really not sure which are questions and which are comments.  So if you would be so kind as to ask them again, succinctly, in a followup, I will do my best to help.

Hope all goes well!

Dana