13 year old male rabbit - chronic snuffles

Question
QUESTION: Hi Dana,

You've been helpful in the past answering my bunny questions.  Lowell has had a chronic case of snuffles (or stuffy nose), and has been on a variety of different meds, (TMS, enrofloxacin, Zithromax). The past week, I've been trying Zeniquin.  So far, I'd have to say that the Zenequin has had no effect; if anything, he may be slightly worse.  His breathing is becoming more labored in the last couple weeks as well.  Dr. Peter Fisher of Va. Beach is Lowie's vet.  A few days ago, I spoke with a vet tech at Dr. Fisher's who recommended trying to irrigate Lowie's nostrils with saline solution might help clear them.  I had concerns about the fluid going down into Lowie's lungs.  But the tech said that most would go down the back of his throat.  Does nasal irrigation work?  Is there anything that you can think of? We've taken a culture and have administered the drug that was supposed to eradicate the problem.  But it did not work.

I've marked this question private because I mentioned Dr. Fisher.  Please don't think that I have anything but the highest regards for him and the other doctors. and staff, who work there.  They're great!  I just don't want to leave any stone unturned in trying to help my boy bun.

Any advice you can offer would be greatly appreciated!

Thank you.

Gratefully,

Anne Evans
Virginia Beach, VA



ANSWER: Dear Anne,

I would be a bit nervous about nasal irrigation, too, though it can help clear the airways.  Has a culture and sensitivity test been done on Lowell's snot?  If not, please see:

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

If the causative "bug" is Pseudomonas, it can be very stubborn, and may require a combination of two antibiotics to really nail it.  We have had success combining Zeniquin with amikacin, but whether this will work for you depends on what the bacteria are and their sensitivities to various antibiotics.

If you are not confident enough about the nasal irrigation to go forward with it, then ask the vet about perhaps trying some pediatric Benadryl nose drops and then suctioning out as much snot as possible with a pediatric ear syringe.  This can work very well, especially if you nebulize the bunny for a while beforehand, to really get the mucus soft and liquid for easier suctioning.  In fact, nebulization might be a good idea for him, in general, especially if there is any suspicion that the infection could be in his lungs.  A nebulizer will run you about $150, but it can make a great difference in the delivery of his meds and the ease of his breathing.

I hope this helps, and that Lowell will be better soon.

Dana

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

QUESTION: Hi again Dana.  I have one more question.  What if Lowell's infection is a fungal infection?  What would be the course of treatment for that?

Thanks again!

Anne
VB, VA

ANSWER: Dear Anne,

Fungal infections of the respiratory tract are quite rare in rabbits, so I would not count on this being the case.  

If he *did* have a fungal respiratory infection, it would be very serious, as it would be in a human, and require rather risky systemic drugs (e.g., itraconazole or ketoconazole) for treatment.  I very much doubt this is fungal, and would *hope* it's bacterial.  A fungal respiratory infection would be much worse than a bacterial one.

Hope this helps.

Dana

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

QUESTION: Hi again Dana.  We have Lowell on amikacin nebulizer and oral Zeniquin.  These are given once a day, in the evenig.  Does this frequency seem like it is enough? So far, after 3 - 4 days, I _may_ be seeing a slight improvement.

New question - Can you please confirm that the above drugs aren't known to cause GI status.  This is Lowie's latest issue. We have him on oral cisapride and cyproheptadine.  So far, after just one dose, some small dried out poops have come out.  But there has been nothing further.  We are also giving Lowie Simethicone and Critical Care, as well as massaging his stomach.

Is there any further recommendation you can make to help Lowie through this?

Thanks always Dana.

Anne
VB, VA

Answer
Dear Anne,

When we nebulize, our vets have us do it every 12 hours.  You might want to ask about that.  In fact, in very severe cases, we nebulize three times a day.

I'm glad Lowell is starting to improve!  What great news!  Keep it up for as long as it takes.

None of the drugs you mention are associated with GI upset or stasis.  It's probably the stress of his illness causing any GI slowdown, and the cisapride and other meds are all good to help counteract this.  Of critical importance, though, is making sure he's well hydrated.  This could involve administering subQ fluids, but it's even *more* important to make sure his intestinal contents are hydrated so they'll move easily and form nice, big poops.  

When we have a bunny with slowdown, we administer lactulose, a non-digestible sugar that acts as an osmotic laxative to hydrate intestinal contents.  It's often a good idea to accompany this with subQ fluids--especially at the outset--to be sure that you don't hyrate the bunny's intestinal contents at the expense of the other body tissues.  

A *shallow*, *careful* enema can also work wonders.  Instructions can be found here:

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

but be *very* cautious if you are not experienced, since the rabbit rectum, while somewhat elastic, can be ruptured if you try to force things.  But if you can get the vet to help you, this can really make a big difference to his GI hydration and poop output.

Hope this will help, and that Lowell (great name!) continues to improve!

Dana