Many problems answers urgent for keeping her will to live despite obvious pain. Raw skin, urine scald above the tail, bladder infection after removal of sludge and stones and now problems with hopping

Question
QUESTION: I am seeing a local vet who has been trying to help us out with this. I have a almost 6 year old, female, mini lop, spayed. She is an indoor rabbit. She has a cage that she is in over night and while I am at work. The cage is large and allows for her to sprawl all the way out (prior to becoming sick) on the one half and still have her litter, food, water and hay all on the other side. All other times she has free reign over the entire house. In September 2012 Polly was diagnosed with urine scald. It was above her tail and goes up about 2 inches or so. She was treated with Desitin. Then her litter box habits went away. The vet diagnosed her with sludge and 2 bladders stones. Surgery was done in December 2012 and this was removed. One week later she was diagnosed with a bladder infection. The following week it was thought no. Then two weeks after that (meaning 4 weeks total by now) sensitivity testing showed a bladder infection. She's been prescribed Baytril for the infection and medacam for pain. It is a 3 week dose and we are 2 weeks into it. Initially the dosage was .27 mL and has been increased to .5 mL just this week (she weighs approximately 6 lbs# Also, Polly is holding her butt real low to the ground while standing, she doesn't sit right and her legs are the not the same when hopping. She is hopping very slowly for her. An x-ray shows that her back and hips are fine. We are doing laser therapy two times per week on her hips/lower back and on her bladder because it may help and doesn't hurt. There really hasn't been much improvement with anything. She's still not able to make it to the litter box, she's dribbling, and then there's the skin irritation. Throughout this, her urine scald/skin infection has remained the same, above the tail. She's always wet there. We are perplexed by this but the way she sits #prior to her recent changes in posture#, put her butt down and that is the area that is scalded. So I put Duragrid flooring in the bottom of her cage so that she would not be exposed to the urine. We also are using synthetic sheepskin for her to lay on while in the cage. I found an article in Rabbit House Society journal pages about mites. A test showed no mites but the vet said it doesn't hurt to treat her anyway. So she was just given revolution #I think). This was 2 days prior to me writing this. The area around her tail is still sore. There is a spot that was raw and bleeding so I've been putting neosporin on it which has helped in that particular spot. The sludge and bladder problems are on hold till we can get her healthy again. The x-ray one month after the surgery showed very little sludge but still has very extended bladder. She's pees a lot in frequency and amount of urine. I have thoroughly examined her diet and she is on a pretty low calcium one. Also to be noted is that prior to the surgery she was a huge water and hay eater. Since the surgery she hardly drinks any water and she eats only a moderate amount of hay. She gets 1/4 Oxbow timothy pellets each day but doesn't always finish them but when I eliminated them from her diet she dropped a lot of weight fast so they were brought back in. Her weight is back around 6 lbs now. She eats her veggies and I'm giving her critical care in baby food and water each night. It's 1 tsp of critical care with about 1/3 cup water and some baby food. If I increase any of the above she won't eat it. She will only eat this at night. Overall we are stumped...on the skin problem, the hopping problem and I just want my healthy and happy Polly back. She's really started to look rough. I'm afraid her eyes aren't as shiny and her coat is looking duller. I don't want to lose her and I am so hopeful that this is a problem that can be treated before her will to live is gone. There are just so many things and we can't figure them out. I'm willing to do anything and am hoping that you have some suggestions and can help us.

ANSWER: Dear Missy

If it's been two weeks without improvement, it may be time to ask about trying a different class of antibiotics.  Anaerobes may be difficult or impossible to culture, but they can be in there causing pain and problems.  Some antibiotics to consider would be:  dual-acting Pen-G Procaine/Benzathine, amikacin (injected with copious subQ LRS), azithromycin, or even cephalexin if the others don't work.  

For pain, ask the vet about a dose of Banamine, though you might want the metacam completely cleared from her system before this.  Ask about an opioid, such as Tramadol or buprenorphine.  

To keep her comfortable, here are some instructions for wet and dry butt baths:

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

If you think the current vet isn't trying all the options, you might check the list linked here for a vet to give you a second opinion:

http://www.rabbit.org/vets

I hope this helps.

Dana

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QUESTION: I did not find this helpful at all and am disappointed in your lack of attention the details I provided and to a matter that is extremely close to my heart! If this is supposed to be informational, as your site states it is, this was a far cry from what is advertised. The options offered of a stronger anti-biotic or pain med doesn't cure the disease and DOESN'T make her heathy. I was looking for information on diagnosiing the problem and healing her; not over medicating her. Then the suggestion at finding a different vet is offensive at best. If my extremely long narrative didn't give away the amount of time and effort our vet put into helping my baby I don't know how much more clear I could be. I lost my princess on Saturday and am totally heartbroken. My vet did absolutely everything imaginable. The diagnosis was E-cuniculi but that was missed by your "expertness"; yet was considered/diagnosed by my vet and treatment began immediatly but sadly it was too late for her. All I needed was a little help and direction before it was too late and the response I got was far from what I expected and far from helpful. You are not a person I would trust in treating my pets!

Answer
Dear Missy,

I am very sorry for the loss of your beloved friend.  I know you are angry and full of grief.  Only time will heal this terrible loss.  But in the meantime, I hope you can take some comfort in knowing that although your Polly had a life that was too short, it was filled with love.  

You wrote to me about this problem on the 17th of this month, and I answered three days later.  If it is any consolation to you, if Polly really did have E. cuniculi (this is verifiable only via necropsy), and you lost her on Saturday (the 23rd), then the parasite had already done far too much damage for treatment (with Panacur (fenbendazole) or ponazuril) to be effective.  This is likely true even if you had written weeks before.  It takes quite a long time for E. cuniculi to cause fatal damage to the kidneys and/or nervous system, and the signs can be very subtle.  

My response to you about her condition was not unreasonable.  Her history of bladder stones and sludge as well as urinary tract infection were clues that her problems might be related to metabolic bone disease, and that is still true.  I know you are angry, but blaming me for your rabbit's death is really not very rational.

Please remember that I am *not* a veterinarian.  I am a volunteer who provides a free service that should not be considered a substitute for veterinary care.  I am glad Polly got all the veterinary care possible, but know that we (including Polly) are mortal.  Sometimes even the very best veterinary care cannot cure a problem that is beyond repair.

Please accept my condolences.

Dana