need help with rabbit, have vet but he is inexperienced

Question
I have a very sick rabbit. He was exhibiting caecal dysbiosis then developed a large lump, like an abscess, that grew rapidly (to 4 cms across in 3 days) under his chin.
My vet in India is not experienced with rabbits so this is a challenge. Lancing the abscess revealed no puss at all, but fibrous tissue growth. The bunny has been put on penicllin and 1ml of paraxin suspension thrice daily. Our vet is afraid to administer NSAID painkillers as the bunny has renal problems, which also means he does not want to administer anaesthesia as he fears the kidneys may fail.
The bunny has stopped eating completely, I am not sure if this is because of the pain, the antibiotics, or both. We are administering saline twice daily (50 - 100 ml each time) intravenously, but he refuses to eat since yesterday. Syringe feeding is not working because he seems so weak he cannot even swallow, and the mashed up critical care porridge or water just stays in his mouth then dribbles out.
Am at a complete loss as to what to do and need professional help. What do we tackle first? the abscess, the stasis? or must we be aggressive and operate on the growth at the risk of damaging his kidneys or worse? Pl help.

Answer
Hi,

I am not a vet, so my advice isn't medical advice, it's a pet owner's advice.

The pain needs to be addressed first.  He's already at risk of dying.  Giving him some pain meds will make him feel better.  Then try feeding.  Rabbits will not eat when they are in pain.

And he probably is in pain as this mass is stretching the skin and muscles under his chin.  Lots of pressure on the skin and surrounding area.  Could also be hurting his teeth and jaws.

If the vet has metacam (meloxicam) available for pain, this would be very useful.  Normally the solution is 1.5 milligrams per milliliter.  Rabbits of about 4 pounds would get .17 milliliters of this once a day, twice if in really bad shape.  Metacam is the #1 painkiller for rabbits in the USA, and you have to have them on it after surgeries in order to keep them feeling good enough to keep eating and drinking.  Rabbits NOT on painkillers will not want to move because they are in pain, even if that means they eat no food or water.  Too much pain will cause them to go into shock.  So getting his pain under control is the most important thing.

Another more natural painkiller to consider is if there are any Arnica Montana pills from a homeopath in your area you can find.  They infuse Arnica Montana (a plant) into sugar pills that you can take for mild to moderate pain.  It might not relieve all the pain but might take the edge off his pain enough for you to feed and hydrate (water) him.

The other thing to consider is if the tissue growth is blocking his ability to swallow.  It would be good if it appears like it is growing under the tongue, or the underside of the neck, to get an x-ray to see where the growth is and if it could be causing him problems eating and drinking.  If that is the case you may need to operate to remove the tissue.  Hopefully that is not the case.

Manage the pain, continue to feed (slowly so he doesn't get any food or water into his lungs) and hydrate (as dehydration will send him into shock and shut his stomach down).  Feeding and keeping hydrated will help his strength to stay and build.

The fibrous tissue growth, are you certain that is not the infection?  Rabbit pus is very thick, it is not runny like humans or other animals.  It could very well be that that was the infection.  Either way it would have been good for the vet to pack that area with antibiotics.

If it is actually tissue it will need to be taken out, but if he's weak you can't operate, you need to build up his strength.

So: manage the pain, get him starting to feel better, continue the feedings and water, build his strength up, and if it is infection, clean it out, flush it out well, and repack the wound with antibiotics, and if it's tissue, remove the tissue and pack with antibiotics.  Keep him warm during surgery, his temperature should be between 100-103 degrees Fahrenheit.  You don't want it dropping as he'll go into shock.  They will need to have some source of light heat around incase, like a heating pad and warm towels.  Rabbits also do not have to be fasted before surgery, as they cannot vomit.  He should have food and water available as he is in recovery, you don't want him to go home without having food and water.  He will need pain medicine after surgery given by you in order to keep eating.