runny cecals - follow up question

Question
QUESTION: Hello,

I have a 5 year old spayed female rabbit who has been having several ongoing issues. She has been seen several times by a vet who I found on the HRS vet list. She has liquidy cecals overnight about once or twice a week, which Benebac seems to prevent on subsequent nights. Her ears also lop halfway much of the time, or she will have one ear up and one ear down. She can still hold them up some of the time though. (She has always had uppy ears until the past 6 months or so.) Near the beginning of this year, I had her treated with a course of antibiotics in case of ear infection, even though the vet said her ears looked normal inside. The droopy ears seemed better after treatment, but came back eventually. Now, the vet (a different one) still says her ears look normal inside. She's had a urinalysis (normal), fecal test (normal), and blood panel (mostly normal but with 1 type of "slightly elevated" white blood cell, but not high enough for the vet to think it was an infection, and very slightly elevated liver enzymes. That was about a month ago and I am getting ready to do a repeat on the blood work because her ears seem worse. Also, she has normal droppings but they have started to vary in size more than usual. There are tiny ones, normal sized ones, and slightly larger ones. She has a healthy appetite, eats all her food and gets excited for pineapple treats. I am not sure if she is just lazy or if her activity levels are lower than usual since she likes to stay in her cage when I open the door. My husband and I just moved into a new home and my rabbit became a house bunny after previously living in a large pen in my parents' garage, so I am not sure of her normal activity levels in this environment. She does come out and hop around at times, acts curious, and does not seem to be in pain. She stretches out comfortably rather than sitting hunched or anything like that.

Question 1: Are there any specific disorders these symptoms might point to? What about e. cuniculi? I have done quite a bit of searching on these topics but can't come up with anything defnitive.

Question 2: What is the diet you recommend for dealing with runny cecotropes? I have gotten conflicting information on this in the past.

Thank you so much for reading and for any insight you might have!

ANSWER: Dear Krista,

Question 1: Are there any specific disorders these symptoms might point to? What about e. cuniculi? I have done quite a bit of searching on these topics but can't come up with anything definitive.

Well...that's because these signs could be due to any number of things, from inner ear inflammation to E. cuniculi.  

Have her molars been checked for spurs?  This could account for both the runny cecals (GI slowdown from pain/stress of dental/mouth pain) and the droopy ears (inflammation in the jaw/inner ear).  Please see:

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

*****

Question 2: What is the diet you recommend for dealing with runny
cecotropes? I have gotten conflicting information on this in the past.

Here's my recommendation for healthy rabbit diet:

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

But if her diet is already okay, then look to dental problems as the culprit.  Please also see:

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

Hope this helps.

Dana

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

QUESTION: Hi again,
Thank you for your previous response several months ago. Sadly, the issue with my 6 yr old spayed rabbit's runny cecals has not been solved, despite numerous vet visits, several blood panels, urinalyses, fecal tests, and an x-ray of her spine to check for arthritic condition. Her teeth are also fine. I am not sure how much I trust my vet either, even though he is an exotics specialist and seems to be the most knowledgeable one I've found so far. (I've taken my rabbits in the past to several vets from the HRS list and have yet to find one I'm completely happy with...)
Basically, her liquidy cecotropes seemed to get better when I eliminated her daily small bit of pineapple cube from her diet, but then it started getting much worse a couple months later. Her butt gets filthy nearly every day and is badly stained and I have been giving her butt baths to help. Her normal poops (which are deposited in normal amounts daily) are also larger and smaller than normal. Most recently our vet prescribed Reglan, but that turned out to only make it worse. Metacam didn't seem to help as well, and before that vet had us try a course of injectable antibiotics just in case of an infection, which did nothing to help either. Results of the blood panels have been mostly fine with slightly elevated liver enzymes. The x-ray came up with mild arthritic signs but nothing major. The other tests were all clear.

Also, I have tried her on all an all veggie and hay diet, and an all pellet and hay diet, and neither one seems to make a difference. She gets Oxbow brand Timothy pellets/ hay. Her appetite is fine.

Can you give me an idea of what other testing you might recommend, and what you think, given the tests/exams we have already done, treatment options might be, or if you think this is likely to be a more serious issue that will just become clearer in time? I am at a loss for what to do besides keep her as clean as possible. Thank you so much for your time!

ANSWER: Dear Krista,

I think it's time for a second opinion from a very experienced rabbit vet.  Did you see this vet examine the teeth?  If he looked at only the incisors, then he can't know if her teeth are "fine".  Unless she was put under anesthesia for a really good look deep into her mouth, it's still possible that she has spurs that can't be seen with a visual inspection.  

Also, buccal spurs (which develop on the top arcade and poke into the cheek) are a LOT more subtle than lingual spurs (on the lower arcade, which poke into the tongue), and many vets will not even recognize buccal spurs that are causing a bunny true misery, resulting in chronic GI slowdown and runny poops.

For now, it might help to get her on probiotics and possibly GI motility meds, so please ask the (new) vet about this.  But seriously...molar spurs or other painful mouth problems are SO commonly at the root of this type of problem that I would not rule it out until a really *good, experienced* rabbit vet has a look.  

I've seen this before, heard of one, two or even three vets saying the teeth are "fine", only to have one vet finally notice the problem, file it down, and the bunny is fine afterwards.

Please check the list here for another rabbit vet:

www.rabbit.org/vets

It may be worth a drive!

Hope this helps.

Dana

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

QUESTION: I forgot to include that the previous vet also looked in the back of her mouth with some sort of "scope" tool. Still not under anesthesia like you say, but I just wanted to add that additional information.

Answer
Dear Krista,

Be sure you have a vet who really knows what to look for.  Buccal spurs (top arcade) are often hard for a vet to identify, as they can look pretty much like a normal molar, if the vet isn't used to looking at a lot of truly normal ones.

I have a photo of the inside of a bunny mouth that I'm Photoshopping to illustrate this, and I'll post it as soon as I can.

Dana