Possible mites, GI issues, underlying illness

Question
QUESTION: Hello there,
At the beginning of Sept 2009, an X-ray and subsequent ultrasound revealed fluid-filled (not pus-filled) cysts in my rabbit's chest cavity.  The cysts are restricting the flow of blood from the head to the heart, so he suffers from swelling in his boy-dewlap and 3rd eyelids and has trouble with his balance.  That has him feeling under the weather and losing weight.  He is 7 years, 6 lbs (and losing), mini-lop.  

I wanted to help him gain weight, so I fed him alfalfa hay but that caused a huge reaction wherein he pulled all of the hair from his abdomen--so I discontinued the alfalfa.  I later tried 3rd cut timmy to give him something special and that caused a reaction worse than the alfalfa wherein he stopped pooping and his dewlap swelled bigger than ever--so I discontinued that and he started pooping again over the next few days.  Then I gave him the diuretic dandelion greens fresh from the chemical free lawn but in two days he became almost unresponsive from sleep one day and the next day he made a big concrete fecal/cecal blob that blocked his anal passage and he was extremely unresponsive until we cleaned him all up--I discontinued dandelions. His cecal were still very foul so I tried bene-bac and that helped him a lot--loads of giant poops within 2 days and the swelling on his dewlap decreased 50%.  Unfortunately, on the 5th day on Bene-bac, his lower abdomen (perhaps the cecum?) became hard and full, like a melon and he had pulled all of the new hair from his abdomen--so I stopped Bene-bac (11 days ago).  My theory is that the oil in Bene-bac helped his intestines move things so well that the fermentable food in them got pushed into his cecum too fast. So, I massage his lower abdomen (which he hated) and make him exercise a little and the lower abdomen seems to have shrunk and soften.   The vets have no solutions for me and I keep trying things.  He is getting stronger.

So, now, things have settled and I am afraid to do anything beyond increasing his pelleted feed a little bit every week to help him gain weight (unsuccessfully--and he is ravenous all the time).  At this point his fecal pellets are very healthy and numerous, but the cecal pellets I manage to catch a glimpse of are still too wet. He is also continuing to pull his fur with a vengence and is now working on his chest fur and side fur and his front legs look like a poodle's.  So now I think he is having a sensitivity reaction to fur mites since with his setbacks he has not been able to clean like he used to.  The itching is driving him crazy.  He no longer licks and nibbles to clean his fur, he yanks it out. He has a couple of spots of dandruff, but it is not moving.  I would like to give him Revolution or Ivormectin anyway, but do not know if it is okay to give to a rabbit in a weakened condition.  My bun eats unlimited timothy hay on which he chows on all night and is up to almost 1/8 cup of Oxbow timothy basics/T pellets. Greens are out because his poops are way better now than they have ever been.

I gave you all this history because you might see a pattern.  Also, I was wondering what I can do for his cecal pellets?  Is it harmful for him to eat foul cecals?  I wanted to change his food pellets to extruded pellets for weight gain but I am afraid even to increase his normal pellets even though he is so very hungry!!  Anything new seems to cause a life threatening situation.  Is there anything I can do to help his cecum return to healthy balance? I thought that the abdomenal fur pulling is so odd and his big reaction to what I think are fur mites are very puzzling and disturbing to me.  I am trying to limit vet visits because that stress is just too much for his fragile condition but if it is necessary to take him to the vet before giving Ivormectin or Revolution then I will take him.   If you please,  throw all of you knowledge light onto my bunny's gut/fur situation.


ANSWER: Hi Leah....First, I applaud you for all you are doing to help your rabbit.  Great job.

I have actually had something similar happen to one of my rabbits.  We even performed fungal cultures.  My rabbit would pull fur (and she had been spayed) and she was so uncomfortable that she would chew herself until she bled.  Since we chart any illness, we also noted a GI issue each time she would experience this hair pulling.  Our original thought was stress.  But we noticed that the issues came at a regular interval.  We dewormed her with Panacur and the problems resolved.  In this case, I would consider Panacur and Revolution as that would cover just about every possible parasite.

Just wondering....has a culture been performed on the fluid aspirated from the cysts?  And did your vet do a skin scraping of the affected area?

Bene-Bac is something we use a lot here.....we do wildlife and it's something we really push with cottontails.  While the bacteria in Bene-Bac is not what is actually doing the work in the gut, it works by stabilizing the pH which creates a favorable climate for the growth of beneficial bacteria.

The cecal problem is most likely due to a bacterial imbalance in the GI.  Do you see any mucus on the regular fecal matter?  Many times in situations like this there is an overgrowth of a harmful bacteria known as Clostridium.  Our usual response to Clostridium is a drug called Metronidazole.  While this drug is an antibiotic, it is also an anti-inflammatory.  We have also been using horse product, BioSponge, which has been a true life saver in all small mammals with a compromised GI.

I know this sounds odd...but does your rabbit ever go outside?  For those of us that do wildlife, we are very sensitive to Vitamin D.  Most house pets are Vitamin D deficient and this can cause all sorts of problems.  Most of the better pellets do contain a small amount of Vitamin D....Oxbow included.  But we are seeing that might not be enough.  Exposure to unfiltered sunlight is essential for some of these animals.  This means not thru window panes or screens.  Direct sunlight.  At the more morthern latitudes, the sun isn't strong enough to provide proper spectrums.  You can purchase "solar simulators" at most pet stores....they are used for reptiles and reef aquariums.

But I would certainly deworm this rabbit immediately.  Fecal floats, which are supposed to check for parasites, are noriously inaccurate, so we just go ahead and deworm if we have any questions. I would also be very interested in exactly what is in those cycts.  We have seen them before....kind of like a sterile abscess.  The ones we have seen have never been in a position to be anything other than a nuisance so we would do a needle aspiration as needed.  But if they are affecting quality of life, especially restricting blood flow, other options may need to be investigated.

I am really wondering, and will give some thought to, the connection between the skin condition and the alfalfa hay.  I am going to print your comments and review it with some of my volunteers....all exotic vets or techs.  If anything new comes up, don't hesitate to contact me.  And I will see what additional information I can find on this concern.

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

QUESTION: If the bun is weak condition do you still deworm as a matter of policy without seeing a vet?

Oh my gosh, thank you so much for answering me so quickly.  I am becoming so anxious about his fur issue (not quite as anxious as my bunny, I'm sure).  I am glad to see that you have noticed this problem with another rabbit and that it had a relatively simple treatment.    I wish I knew where the parasites came from.  Thank you also for looking more into the alfalfa hay connection.

The fecal pellets are perfect, no mucous, large and light brown to dark brown with light colored flecks.

He is a house rabbit and never goes outside.  We have just built a hutch for him that gets lots of dappled morning sun--I will start putting him out there in the mornings before it gets hot.  

We have decided not to have the aspiration done.  The vet advised strongly against it because the cysts have moved the organs all around and he is not in good health.  It is not an abcess in there, it is water filled, and I suspect that it fluctuates with immune responses (although the vet does not think so--she thinks it is random).  Wouldn't it be interesting if the cysts were related to a parasite??

Answer
Umm...I have seen parasites put a rabbit totally unable to move.  She is still here with me.  When deciding on a medical treatment, the thing is to determine if the possible benefits outweigh the possible risks.  In the case of parasites, they can certainly debilitate any species.  And I prefer to make sure there are no parasites in there.  I decided in the rabbit that was on her side that she would not survive without deworming...and she survived.  I certainly would not attempt this without the supervision of your vet.  If there are a large number of worms, the dead and decaying worms can lead to some issues.  Another parasite that is commonly found in rabbits is coccidia.  Most vets are still using Sulfanomides (a class of antibiotics) but my non-professional experience has shown that this type of drug isn't very effective against the coccidia and can harm the beneficial bacteria in the gut.  I use a horse drug, Ponazuril (Marquis) as an anti-coccidial.

Parasites can come from most anywhere.  Some can come in on your shoes just from walking across grass.  They can also be on fresh greens.  I have never encountered a situation where parasites caused something like these cysts...but I never rule out anything.

This is a kind of "out there" thought....but has your vet given any thought to using a diuretic to see if the cysts changed since aspiration isn't an option?  Lasix is one of the most common drugs used.  It seems to work a bit different in rabbits but we have used it successfully several times.  I might would consider using a NSAID, usually Metacam, to see if there were any improvement.  NSAIDs are appropriate only for short term use to protect the liver and kidneys.  Again, only under veterinary supervision and it might not be appropriate in every situation.

Something I would suggest is a complete CBC with EC titer.  There are only a few labs that can titer blood for EC.  This is a protozoan infection that every domestic rabbit has been exposed to.  Under normal conditions, the immune system will keep this little nematode in check but if the immune system is stressed, EC can make an appearance.  It is a very misunderstood affliction.  Most of the reference material on this issue is horribly incorrect.  EC invades the brain.  Usually the first presentations of an active infection are some type of very light paresis most of the time in the left rear leg and some degree of urinary incontenance...but these presentations may be very mild and may not be something you actually see.  Since the parasite is in the brain, the immune system responds to it as a major problem, and it is, but the immune system also drops it's guard against some of those sub-clinical bacteria and that can lead to some unusual problems.  EC is very difficult to treat since the normal drugs used (the "bendazoles") have a difficult time penetrating the blood/brain barrier.  But anytime I have an older rabbit with unusual presentations, I have to at least consider EC as a possibility.  I use a combination of Ponazuril and Panacur to treat this.  If you want to do a search for this infection, it's actual name is Encephalitozoon Cuniculi.  I will also caution you that a lot of the information that you will find is inaccurate....and in some cases it is very frightening.  Most vets have never seen a full blown case of EC.  And if you do search for this, don't let it upset you...this is just a possibility to consider.  

Again, I would not suggest attempting any of these possible treatments without your vet's supervision.  He/she is in the best position to make the call regarding treatments.  Just offering topics of discussion you can use.  Keep me posted.

ADDITIONAL INFO:I have been doing some research on allergic and immune responses to alfalfa.  I have not found any documentation of this reaction in rabbits but some humans have developed dermatitis after coming in contact with alfalfa.  So since we know that animals can have allergies, it seems that it is possible based on the limited info I can find.  Will continue to research.