Liver Disease in young rabbit

Question

Maggi   QUESTION: I have a 10 month old bun that was suffering from coccidiosis when I found her 8 months ago.  She was treated with Septra (trimethoprim sulpha) and she managed to survive.  At the time her liver was slightly enlarged so now that I want to get her spayed, I am concerned about her liver enzymes and the anaesthetic.  I had blood work done on her and sure enough most of her blood chemistry is out of normal ranges and indicates liver disease.  I do not use pine shavings but the kiln dried pellets with paper and hay over top.  She has been energetic and had a big appetite until lately.  The vet would like to treat her with vitamins and milk thistle but we haven't started that yet.  Today she didn't want her pellets (which she usually devours) but would eat grass and dandelions and nibble on alfalfa hay.  Is there anything that I can do to make her more comfortable when she refuses her usual food?  Should I give her subQ fluids?  I've decided to not have her spayed and we will repeat the blood work in six months or so.  I am concerned about her apparent unhappiness today though.  Thanks.

C

ANSWER: Dear Caroline,

Abnormal liver enzymes can indicate any number of pathologies, from chronic infection to parasites.  Since she has a history of coccidiosis, I would worry that she may have hepatic coccidiosis.  

We no longer use the potentiated sulfa antibiotics to treat this parasite.  We now use ponazuril (toltrazuril sulfate), which has given us excellent results. For domestic rabbits, we've found that some strains of Eimeria (the name of the protist that causes coccidiosis) are more resistant, and we've had to give ponazuril at a dose of 50mg/kg, instead of the usual 20, to get it under control.

If this were my bunny, I would ask the vet about putting her on ponazuril (Baycox or Marquis; we use the latter) for a month before spaying her.  This will allow her liver time to heal, too.  Followup bloodwork will tell you whether she is ready for surgery or not.

But in her current state, I would NOT risk anesthesia nor surgery.  That's why you do bloodwork in advance:  to tell you if there's a problem that increases her risk.  And bad liver enzyme readings certainly indicate increased risk of problems.

If she is an only bunny, there is no reason to rush this.  Get her liver well, get her fully healthy, and *then* consider the spay surgery.  While it's true that unspayed females have a high risk of uterine cancer, it's not exactly as if she's a time bomb.  She has time, and so do you.

As far as her appetite is concerned, this could be another indication that all is not well.  Consider that the coccidiosis history could be a Red Herring, and she might have an infection somewhere in the system that needs treatment.  Please read:

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

to learn how to safely take her temperature, which can tell you a LOT about her basic state of health and whether this is an emergency.

I hope she will be fine soon.  She is ADORABLE!!!

Dana

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

QUESTION: Thank you Dana.  I did try to track down the Ponazuril to treat her initially but it proved to be too difficult to get here in Canada.  Only horse vets carry it and they are only willing to sell it in large, very expensive (hundreds of $) quantities.  Hence the fall back to the apparent next best thing, Septra, which did seem to help her.  It got her poop back on track for certain.  Her sibling who was displaying the same symptoms (bloated belly, diarrhoea, apathy) but went to another home and was untreated did not survive.  She was never clinically diagnosed with Coccidiosis, just assumed to have it because other bunnies from where she was found had died and necropsy confirmed coccidia infested livers.  Is there any point in dosing her with Septra again?  If you hear of availability of the Ponazuril for rabbit dosing in Canada can you please let me know.  I will put out a plea for it on BS.  Is there any way that she can overcome the coccidia and regenerate her liver without ponazuril at this point?
Thanks again,
C

Answer
Dear Caroline,

Septra would be better than nothing.  But how about trying to get Baycox through this vendor:

http://www.horseprerace.com/baycox-toltrazuril-200ml-p-29.html

No prescription required, but I don't know whether they can ship to Canada.  Perhaps your vet can order it?  It is not expensive.

Dana