Rabbit with Serious Chronic URI--Any Other Treatment?

Question
QUESTION: Hi, Dr. Krempels,

I volunteer for the House Rabbit Society and am helping care for a sanctuary rabbit who has a serious and very chronic URI. She has terrible trouble breathing, and it's affecting her eating. She had an episode two days ago when she was eating a raisin and could not breathe.

She recently lost her partner, but was seemingly rebounding; eating and pooping well, getting loves and pets. However, she periodically has episode where she hacks and coughs and sounds like she can't breathe for seemingly 10 seconds, which is very scary.

She was on two antibiotics, but her URI does not seem to be getting better, so she went back to the vet. He ran x-rays and she does not have pneumonia, but is now on 3 antibiotics to try and kick the bug. I don't know if they did a culture to test which antibiotic would be most effective. He did give her some sort of relaxing agent, because she was so stressed out (I don't know what kind; wasn't at that visit). She does seem a very sensitive bun, and the loss of her partner has understandably made her even more so.

Since the first vet visit she did not eat much. After the second she stopped eating all together. We gave her propulsid and peds simethicone to help her motility, and also gave the antibiotics crushed in a little orange juice. I gave her critical care, which she seemed to really want, and ate willingly. Just seems that her breathing is making it hard to eat more generally.

Two questions:
1. Do you know of any meds that might be like rabbit Sudafed that could help dry out her nose, without affecting her heart rate or other vitals?

2. Is there anything else we can do to help her? She just seems so miserable.

Thanks in advance for any suggestions. Best wishes,
Jen

ANSWER: Dear Jen,

If she has nasal discharge blocking her sinuses, then ask the vet about trying a gentle nasal flush, even if via a tear duct flush.  This could help liquefy any snot/pus in her rostral sinuses and help her breathe.

I know that many rabbit vets prescribe Benadryl to help with sinus inflammation interfering with breathing, though I've never used this myself.  And if you're absolutely sure it's her sinus passages that are blocked, not her lungs, then it would be merciful to at least *try* something like pediatric Afrin to open her airways.

If she is breathing with her nose tilted upwwards, then I would still not rule out pneumonia, even if the radiographs didn't indicate congestion.  I've known of rabbits who had normal-looking chest rads, only to show lung infection on necropsy.  Also consider the possibility of a thymoma, if she is simply having trouble breathing without showing signs of nasal discharge or obvious infection.  We are seeing this a lot.  :(

What are her exact signs?  Discharge?  Mouth breathing?  Chest heaving? With a bit more information, I can be of better help.

Hope this gives you some ideas, though.  Sending healing thoughts for the poor girl.

Dana



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

QUESTION: Thank you so much for your reply. You are always so helpful.

I have not seen much nasal discharge at all, but have only been caring for her regularly for the past two weeks (other than seeing her when cleaning on weekends about once a month or so). Her main symptom is that she sounds like coffee percolating, and has the wracking episodes when she coughs and sounds like she can't breathe at all. Sometimes she's silent, but most of the time she percolates, especially when she moves. She did have some spells of stretching her neck to breathe the night she went to the vet this week, when he put her on the third antibiotic.

This morning she was worse--the morning volunteer found her on her side with labored breathing, and every few minutes her hind legs would tremor significantly. We called the vet and a volunteer took her immediately.

She has been urinating on herself since the vet visits, and seems to have had difficulty hopping normally. I attributed this to her gi slowdown, but the vet said she was favoring her right front leg, and her elbow is swollen (but no fractures). The propulsid seems to be working this morning; the volunteers said they saw some small poops on her butt when they picked her up. The vet is keeping her over the weekend for treatment and observation.

She seems to have gone downhill quickly, and I can't tell if this is related to gi slow down, breathing worsening, both, or something else, and the vet did not say much to the woman who took her today, other than noting that she had Critical Care on her nose (though it was not in her nasal passage), and that she was favoring her right front paw and her elbow was swollen.

Would thymoma show on the chest rads, and would that also explain the percolating and coughing? Would gi stasis and/or trouble breathing cause the leg tremors? (They were pretty serious, and shook her x-pen, which she was leaning against.)

The other volunteers and I feel particularly bad because her mom is out of town on vacation until early next week, and though we've been trying to take good care of her, it's not like having her usual sanctuary mom there, who knows her behavior inside and out. I will share your suggestions with her mom, so she can share with the vet, since they are not open again until Monday, and didn't mention keeping in touch with us to let us know how she's doing over the weekend (which is distressing).

Thank you again for all your help, and we appreciate any and all suggestions you can share, as well as your healing thoughts for her. She really is a sweet, sweet bun. It's so hard to see her like this and feel like we can't do much to help. :(

Best wishes,
Jen


Answer
Dear Jen,

The percolater sounds mean there is fluid in her lungs.  And if her elbow is swollen, it could mean that lymph is collecting there, and that her circulatory system is failing, if the elbow was the lowest point of her body when she was found lying on her side.  (The elbow edema might not be significant, but I wouldn't ignore it.)

Has the vet considered congestive heart failure?  If the vets can get her on palliative treatment (diuretics?) to get rid of some of her excess fluid, that could buy time for drugs meant to treat congestive heart failure to work, if CGF is a possibility.

Renal failure could also produce signs like this in its very late stages.  Has bloodwork been done to check her B.U.N. and creatinine levels?  If her kidneys are failing, there is really nothing more to be done except keep her as comfortable as possible.

I think I mentioned that we've had rabbits reveal lung infections on necropsy, though their chest radiographs were clear.  So maybe ask about nebulization with sterile saline solution cocktail containing aminophylline, acetylcysteine, and amikacin, if the vet suspects this still might be a lung infection.

If you are not sure the vets treating her are doing all diagnostics possible, then try to find another vet here for a second opinion:

www.rabbit.org/vets

I hope this helps.

Dana