Trimming a molar/kidney disease

Question
Hello, you've helped me in the past and I thank you!

This time I want to ask about our 7 yr. old dwarf.  She has spirit still and she also has been diagnosed with kidney disease via bloodwork.  That was over 2 months ago.  

I understand that if kidney disease is diagnosed by blood, that 75% of the kidneys are already affected.  Is that true?  I'm wondering how long she has left.  She still has a good appetite, does not drink continuously that I've seen.  It's hard to watch her constantly as we have 30 rescue bunnies but she's very well taken care of.  Our bunnies are all pets and lots of personal attention.  Snowball loves her veggies as well which I've been chopping up since her surgery.  She has a hard time with big pieces.

What I'm concerned about too is just over 2 months ago, she had to have a molar taken out as it was cracked and abscessed.  I truly don't know how that happened as this bunny is not a jumper or runner and she likes to tiptoe around.  I've never dropped her in the 4 yrs. we've had her.  The molar that was extracted was the 2nd molar on top which perplexed the vet (who's an experienced rabbit veterinarian).  She thought it would be the first molar.

That said, now the 1st molar is a little 'askew' it was described.  She said she could trim it but is a little cautious about doing that now if Snowball is still eating pretty much and behaving normally.  The thing is, Snowball's not eating hay since her surgery.  The vet doesn't think it's from the extracted molar but the 1st one that's needing trimming sometime.  The vet still doesn't want to take that chance putting her under anesthesia because of the small chance something may happen and the bunny hasn't shown other signs of teeth pain, etc.

What do you think?  Snowball is now on a mix of Martin's Less Active and Oxbow Timothy pellets.  I want her to eat hay again, she used to love it.  Her partner is also now eating the pellets with her and I'm afraid he won't eat his hay as much now.

Thank you for any help!

Paula

Answer
Dear Paula,

With kidney disease, it's nearly impossible to predict how long or what quality of life the patient will have.  I have known of bunnies with bad BUN and creatinine readings who lived for *years* when allowed to simply manage their own fluid intake by drinking an unlimited supply of clean water.  And others who have not lasted three months, despite treatment.

If the problem that caused the kidney damage in the first place has been arrested, then she could go on for a very long time.  If the disease is progressive, then she may not have as long.  The key is to monitor her behavior, and if she seems "down" to ask the vet if it might be a good idea to *occasionally* give her some subQ Lactated Ringer's solution as a helper.  Too much of this can be very bad, as human physicians discovered years ago, and some veterinarians are only now realizing.  

By keeping an eye on her moods, appetite, etc., you can determine whether she needs some therapy, or whether she's managing well on her own.

The molar problem is a bit sticky.  If it's a lingual spur, then some very experienced vets can actually file them with light sedative and no full anesthesia.  Buccal spurs (on the top molars) tend to be more difficult, as they are often closely appressed to the cheek.  But if this is causing her discomfort, I'd see what can be done to get rid of the spur.  A constant, nagging scratching and poking in the mouth has got to affect her quality of life, and she could improve if the spur could be filed.

I completely understand the vet's caution.  This is not a decision that's easy to make, and if it ain't broke...etc.  But if the vet thinks it might be possible to file the spur without total anesthesia, it might be worth a try.  I do this with my rabbits all the time, and lingual spurs are not hard to file, even with the bunny completely unsedated.

I hope this helps.

Dana