FOLLOW-UP: respiratory problem followed by urinary

Question
QUESTION: My rabbit is a 9.5 year old Dutch female, weighing 3 pounds 10 oz.
She has lost about a half-pound since last year. She has always been a healthy rabbit (street rescue), with one exception.She has always had "the sneezies" (probably pasteurilla) but it became "more often than less" since July, so took her to the vet. It was accompanied by clear nasal discharge, with an occasional green solid discharge (about one per week over the past 3 weeks).

She has been seen by the vet weekly for three weeks. The first week she was on Baytril (.42 cc/2x daily)(as she was in July) and also Benebac (2x/daily). After one week, the vet extended that treatment for one more week, but on that 2nd visit, was also concerned about the amount of calcium in her urine (crystals last July). (I did give the meds at separate times, with Benebac following the Baytril by about 3 hours).

So week 2 was repeat of the same meds as for Week One...baytril and benebac. Also did a urine test on week 2. Didn't show crystals, but somewhat elevated calcium seen. Also sent us home with Sub-Q fluids (50 cc/day), which we will have used for 14 days as of next TH.

Week three visit. Still concerned about the amount of calcium in the urine. Sent us home with Medicam (.11 cc/once daily), and told to give Benebac for 2 more days (2x/day). Also continuing w/ Sub-Q fluids for second week.

Rabbit seems a little lethargic (doesn't run around on free time, is mostly content to sit), and not as full of spunk as usual. Vet gave Medicam because she wonders if she is having any pain due to bladder. Vet also told me to turn the bunny upside down and back, and then manually express her urine this week (one or two times a day) to help fully empty the bladder and to mix the sludge up (turning the bun bod).

She eats her pellets, hay and salads (romaine and cilantro) and drinks well (food and hay, timothy based). Vet wonders where she is getting the calcium from.

Mentioned to the vet that a friend of mine's rabbits have shown positive response to Orbax for urinary, but she left her on Baytril for those first 2 weeks.

Your comments are really appreciated.

Thanks, Dana. I appreciate the time and care that you take to help us Bun parents out.

ANSWER: Dear Carol,

Rabbits often have elevated Ca++ levels compared to other mammals, so the "high" levels may not be off the charts.  Also--and it may sound odd--the bunnies with metabolic bone disease that we see often have *low* blood Ca++ levels, possibly because they are mobilizing and excreting it more quickly than normal rabbits.

Hard to say why she is lethargic.  There could be multiple reasons.  Metacam is a good idea to see if it perks her up, but note that it does reduce blood flow to the kidneys, which can be problematic for bunnies with true metabolic bone disease.  

In rabbits with MBD, diet doesn't seem to have much of an effect.

Has the vet considered a urine culture and sensitivity test?

Dana

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

QUESTION: Following up...

Thanks Dana, for your comments above. VERY much appreciated.


The vet has indicated that she is very hesitant to do a urine culture, as it has risks, and she feels she would have to anesthetize the rabbit, which has additional risks. She has indicated that a "catch sample" is inadequate for urine culture/sensitivity test due to contamination.

Have been reading the other posts on MBD and urine culture/sensitivity, very interesting.

Vet has been telling me to remove all sources of calcium other than romaine and spring mix. This doesn't seem to jive with what I'm reading about importance of not removing dietary calcium in reasonable amounts.
I assume I am correct in still giving this rabbit (and my older rabbits) calcium veggies in moderate amounts(and FL specials such as Asiatic Hawksbeard (southern replacement for "dandelions"), especially since (dandelions)also perform a mild diuretic effect?

I'm reading that MBD is pronounced in specific "breeding" of rabbits. With this rabbit being a Dutch (with great markings, I might add...but that is never important to us!), might she be more predisposed to MBD for this reason? As you can tell, I am much interested in "what and why".

We go for our 4th visit tomorrow (no antibiotics this week, only Sub-Q, Medicam, and urine expression). The bun HAS been a bit more animated this week, so I have hope that this is working.  The rabbit is eating normally, pooping, and peeing....albeit she has always been a "perimeter pee-er" (her pen is next to another female who "visits" the Dutch's "pair-guy" and I have always thot it was just her way of saying "Mine!".

But at the same time, I'm wondering if I need a 2nd opinion, due mostly to the position on calcium-veggies, and hesitancy to do the urine/sensitivity culture.

I am assuming that the test would tell us if we are dealing with bacterial infection vs. MBD??

Thanks, Dana!

C.

Answer
Dear Carol,

It's not impossible that you are dealing with *both* MBD and an urinary tract infection.  But I'm hoping the fluid therapy and other treatments will at least reduce the sludge load.  This can help resolve irritation of the bladder lining that (some think) might promote sludge formation.  But no one really knows.

Some people believe that a bit of cranberry juice can help, as it does with humans.  It might not hurt to try a teaspoon a day and see if there's any effect (though with so many variables, it would be hard to know if that was the trick!).

A second opinion from a really rabbit-savvy vet is never a bad idea.  You might be able to find one here:

http://www.bio.miami.edu/hare/vets.html

or

http://www.floridarabbit.org/html/vets.html

I hope this helps.

Dana