Rabbit in treatment but unsure about diagnosis

Question
QUESTION: Dear Dr. Krempels,
I am from Spain and I share my house with two bonded dwarf lop rabbits, both are spayed, they are a female of 7 and a male of 1. They live in a huge condo while we are not with them at home.
The female had a gut stasis episode two weeks ago, she was treated with cinitapride, meloxicam, ranitidine, trimethoprim-sulfa, silymarin, oral fluids and syringe feed, but no improvement was showed, more tests were done by her vet this week and we found two ribs broken. The issue is that we do not known if the fracture was the cause of this episode, or the ribs were broken time ago and they could not reach to join properly, because there are no diference from x-rays of the ribs after this two last weeks.
Nowadays she still shows dysuria, tiny faeces, apathy and anorexia, and she is given cinitapride, meloxicam-tramadol (0,3mg/kg+6mg/kg), ranitidine and syringe feed.
All other test seems okay, just a little low hematocrit and WBC. We also did urinalysis and ecography and we are waiting for TSH-T4 and adrenal glands results.
We do not know if rabbits with two floating ribs broken could suffer so much and seem so depress even taking analgesia or we are overlooking something.

I would appreciate your opinion and advice. What would you do if she was one of your bunnies? I owe her a lot and i am very worried.

Thanks in advance, for attending me, and for all the information you are given to improve the lives of so many mistreated rabbits just by the lack of knowledge of their owners.

ANSWER: Dear Noella

In a lop bunny this age, the first thing I'd do is look deep into the mouth to check for molar spurs or other signs of dental disease.  Please see:

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

The floating ribs are very odd, but it's possible she might have fallen in an awkward position when you were not home (is the condo multi-storied?), or possibly been so startled or frightened by something in the house that she bashed herself around badly enough to break those bones.  (I hope the two rabbits are not fighting while you're not home!).

To immediately get a handle on the ileus and anorexia, please read this:

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

and read the instructions for giving an enema.  This will get her GI tract moving faster than any drug, and combined with pediatric simethicone suspension (for gas) and gentle tummy massage, this can get her feeling much better very quickly.  The ileus/GI stasis is the most pressing thing to treat, though it's ultimately important to find out *why* she is having this problem.  Pain/stress are common triggers for ileus.  The broken ribs may be a Red Herring, but certainly pain from those could be contributing.  

But I would still not overlook the very common possibility of dental problems.

Also, if the vet did not check for infection via taking her temperature, please check:

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

for instructions.

Finally, trimethoprim sulfa is a rabbit-safe antibiotic, but it's truly not very effective against most of the common pathogens that cause infections in rabbits.  If there is nothing to culture, a better "first guess" antibiotic might be Baytril (enrofloxacin) or it's very close cousin, ciprofloxacin.

I hope this helps.

Dana



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

QUESTION: Dear Dr. Krempels,

Thank you so much for your guidance, we have put her on ciprofloxacine and we are taking care of her GI disorder closely.

As you said that the broken floating ribs could be a Red Herring, I am wondering if spayed rabbits could suffer from osteopenia as humans in menopause. I have read that no fractures are usually sawn in pets because of that, due to they are closer to the floor than humans (in height), but osteoporosis treatments are tested in spayed laboratory animals...

Do you know something about that? any treatment or test available?

My sweet rabbit has had a lot of exercise daily, but as we live in an apartment, she has not direct contact with sunlight...

As you said, she lives in a multi-storied condo, so probably she fall when we were not at home...her mouth is totally ok (even roots in radiographs) and thanks god, her mate is the best nurse for her, as they are inseparable and he licks her endlessly.

Again, thanks a lot for your support and sharing your knowledge with us to improve the life of our bunnies.

Answer
Dear Noelia,

Yes, rabbits who don't have their ovaries will suffer the loss of bone density, just as humans do.  This can be compounded if they are not exposed to sunlight.  So if possible, try to get her into a place where there's natural sunlight for as little as just 15 minutes a day.  It could really help improve her condition.

I hope she'll be fine soon.

Dana