bunny in Mumbai, India needs your help! - have vet but inexperienced!

Question
QUESTION: Snowy the bunny is a 4 year old male rescued from a pet shop as an infant.

He almost died the first few months we had him, due to my ignorance and a diet that induced gastrointestinal stasis. He was saved by a local and much respected vet. Dr. Rajadhyaksha, who by his own admission has no experience with rabbits but educated himself as best he could. This is typical of most vets in Mumbai - they are very good, but almost all only treat cats and dogs, and in 4 years we have been unable to find a vet with significant experience with rabbits.

Snowy lives indoors with the family and is never caged. He has free run of the rabbit-proof areas of the apartment and a terrace attached.

Snowy's diet consists of pellets (20%) and fresh greens (80%). The pellets are imported to India and are not always readily available. In addition, the brands imported are not consistent and, while we prefer to give him plain, high-fibre (>15%) pellets, the variety we have had for the past 5 months has all sorts of other stuff (corn, seeds, etc.) mixed into it, which I am not sure is a good thing. But Snowy demands his pellets.

Leafy vegetables include broccoli, carrots, pea-pods (on occassion, but never peas), spinach (he eats tons of this), bok choy, parsley (when he feels like it), mint, dil, coriander (loves it), etc. He also insists on a big chunk of banana every morning and a bit of plain toast when we have breakfast. He will beg unashamedly until he gets it.

I am aware that hay is an important part of a rabbit's diet but this, surprisingly, is extremely hard to come by in our over-developed city. We have managed recently (2 weeks ago) to find a supplier for long grass, however, but Snowy refuses to eat it and has to be coaxed and hand-fed.

About 4 months ago, he delivered a nasty abscess under his chin, where his skin is loose. This was treated by Dr. Rajadhyaksha using penicillin injections 3 days a week for 2 weeks. The abscess appears to have been treated successfully.

2 months ago, Snowy began to drool and had occasional bouts of diarrhea - typically in the AM and late evenings (when he produced caecotropes). He is not overweight so I do not think it was him crushing them. The diarrhea only occurred occasionally, and was not consistent (his other droppings were fine, and some days he had no diarrhea). The drooling did not stop and got worse. I read your columns, and other blogs, that said this could indicate dental problems and took him to see Dr. Rajadhyaksha who said that his teeth seemed fine but he could not get a good look at the molars unless we put Snowy under anaesthesia.

We took Snowy to another vet for a second opinion, and she said his front teeth were slightly overgrown and offered to cut them with pliers. We did not permit her to do this since I believe that this could cause microfractures and his front teeth honestly did not look overgrown with reference to the material I could find on the net. This doctor also could not examine his molars, but said that a cursory visual inspection showed he seemed fine. She felt the problem was a stomach infection, and prescribed a 10 day course of 0.5ml of both a probiotic (Nutrolin B syrup - used for children) and an antibiotic (Metrogyl/Flagyl), twice daily. I did check and the antibiotic is recommended as safe on the internet.

However, it's been almost two weeks since that course ended and Snowy continues to drool. His bouts of diarrhea persist. The drool/diarrhea combination and your articles lead me to believe it is a dental issue. He sits hunched up and this is unusual for the confident bunny he is, typically always splayed out like a rug. I visited the original vet, Dr. Rajadhyaksha, yet again, and took him printouts of your diagnosis in similar cases, and he decided to x-ray Snowy's head (to examine the teeth without knocking him out). He also took urine, stool and blood samples.

The right profile X-ray showed that the molars have grown down toward the jawline, so that they look as though they might break through the jawline itself. According to Dr. Rajadhyaksha, the front teeth are fine.

The stool report was normal.

The blood and urine report indicated renal problems, as under:
WBC 16000
Urea 126
BUN 59
Creative 3.6
Specific Gravity 1.25

Dr. Rajadhyaksha felt that this may be a lab error, as Snowy still has a healthy appetite. He called us in yesterday for a second blood test, but could not draw enough blood out of Snowy's veins in either ear. These were bruised after his attempts and, even though he did use an anaesthetic gel, I am sure that Snowy was uncomfortable and I would not like to see him go through that again. So we have no second blood test.

I will try to obtain a second urine sample tomorrow AM, but it is a bit tricky and I need to scoop it off of the floor (Snowy refuses to pee in a litter box). Dental surgery under anaesthesia is scheduled for Friday. My concerns are:

   * my vet is not experienced with rabbits and has never used isofluane gas with them (although he has with cats) - he has made it clear that there is a risk involved because they have delicate chest cavities, and, though he has the knowledge and equipment, he lacks the experience - is there anything you may be able to share with him that could help please?

   * my vet is also concerned that if Snowy does have a renal problem, blood pressure may be affected by the anaesthetic if his kidneys are weak - since we do not have a second blood sample, should we try again? or should we be aggressive and proceed with dental surgery?

   * should Snowy not eat prior to anaesthesia? and if so, how long prior please?

   * our vet has the equipment necessary to grind the top of his molars to the gumline - I have read that bunnies have a lower gumline behind their front teeth than before it - is this true of the molars as well please (don't want him cutting into his gums)?

   * will grinding the top of his molars to the gumline allow his teeth to grow normally and relieve the downward growth to the jawline?

Snowy is our family and it breaks our hearts to see him so. Please do let me know if you need any additional information.

Sameer Hafiz

ANSWER: Dear Sameer,

It does sound as if Snowy has molar problems causing him to drool.  I'm sure you've already seen this, but see:

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

and

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

In response to your questions:

* my vet is not experienced with rabbits and has never used isofluane gas with them (although he has with cats) - he has made it clear that there is a risk involved because they have delicate chest cavities, and, though he has the knowledge and equipment, he lacks the experience - is there anything you may be able to share with him that could help please?

Isoflurane is generally very safe for rabbits, though there are always risks with general anesthesia.  You might ask about giving Snowy a sedative (a bit of diazepam, perhaps) beforehand, so that his stress is minimized.  The less stress beforehand, the less likely he is to have problems with the anesthesia.

  * my vet is also concerned that if Snowy does have a renal problem, blood pressure may be affected by the anaesthetic if his kidneys are weak - since we do not have a second blood sample, should we try again? or should we be aggressive and proceed with dental surgery?

This is a tough call.  We have had bunnies in severe renal failure go under isoflurane and they have done fine.  But it is a risk, as the vet has said.  This will have to be your call.

  * should Snowy not eat prior to anaesthesia? and if so, how long prior please?

Snowy should NOT be fasted.  He should be allowed to eat almost up to the time he goes to the vet.  Rabbits lack a vomiting reflex, which is the main concern for anesthesia (which can cause vomiting when the unconscious animal begins to wake up, and this can cause fatal aspiration).  A rabbit's stomach should never be empty, and fasting before surgery will slow his recovery.

  * our vet has the equipment necessary to grind the top of his molars to the gumline - I have read that bunnies have a lower gumline behind their front teeth than before it - is this true of the molars as well please (don't want him cutting into his gums)?

I would not want our rabbits molars trimmed completely to the gumline!  I see no reason to do this.  The only thing our vets smooth down when they do a molar float is the sharp spurs on the lingual surfaces (lower jaw) or buccal surfaces (upper jaw) that might be protruding into the tongue or the cheek, respectively.  Other than that, the molars should not be filed lower than normal.  Doing so might cause them to grow back unevenly, if some of the molars are compromised and not growing normally.

  * will grinding the top of his molars to the gumline allow his teeth to grow normally and relieve the downward growth to the jawline?

Only if his molars are unusually long to begin with.  The upper molars are usually quite short, and the lowers are much longer.  If the vet sees that the uppers are abnormally long, then filing them short (to perhaps 1-2mm beyond the gums) might help equalize things.  But there are no guarantees.  

It sounds as if you have a very good vet with good instincts for this!

I hope Snowy will be fine.  He is lucky to have such a loving family!

Take care,

Dana

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


Snowy's reports   QUESTION: Thank you so very much for your help Dana. Our vet is trying to organize dental equipment here so has postponed dental surgery till mid next week.

In the meanwhile, Dr. Rajadhyaksha has asked if you would be so kind as to share your opinion on Snowy's X-ray and test reports (attached)? Since I cannot send a zip file using the All Experts email system, I have labelled it Snowy.jpg; may I request you to please relabel it as Snowy.zip and unzip it? Sorry about this but there are about 5 documents.

Thank you again Dana.

Answer
Dear Sameer,

I'm don't have enough experience reading radiographs to really advise you on the image you sent.  It's clear that the molar roots are quite long, and are beginning to impinge on the lower side of the mandible, but this isn't uncommon in older rabbits.  Because the angle is oblique, it's hard for me to tell just how long the upper molars are.

I don't see any sign of infection, which is a good thing.  

The best way to see what needs to be done in terms of molar filing is to actually look in the mouth, which is best done under anesthesia.  I hope Snowy will do fine, and a molar filing shouldn't take all that long, if any spurs are found.  

I wish I could do more, but it's a little hard to judge things at such a distance.  :(

I'm sending lots of healing thoughts for Snowy!

Dana