temperature regulation

Question
QUESTION: Dear Dana,

My foster rabbit Tira Misu has a history of head and jaw abscesses, and has had 3 abscessed molars removed by our excellent  bunny dentist.  He has scarring in the back of his mouth, and gunk (food particles and fur, mainly) accumulate back there and cause ulceration and infection on the inside of his cheek if it isn't cleaned out daily.  I use an eyebrow brush with a long handle to gently ease along his cheek, twirl around, catch up the fur/particles and pull them out.  Then he gets a little squirt of chlorhexidine oral solution back there.  He has been on bicillin, but with his most recent abscess he started having gut problems - lots of gas - so I took him off the bicillin to give his gut a chance to recover.  He is eating pellets, chopped veggies, and I still give him critical care to make sure he keeps putting weight back on.  He is not able to eat hay as far as I can tell.  He was off antibiotics for about a week, and I just put him back on baytril because I'm concerned about the spot in the back of his mouth where the gunk accumulates.  A little bit of pus has been coming out on the brush.  Anyhow, I have 2 major concerns about him that I'm hoping you can advise me on.  

1.  Ever since his most recent molar abscessed, he has had trouble regulating his body temperature.  Even when the house is kept at 70 degrees, his ears get very hot, and he lies down flat until I cool him off by putting witch hazel on his ears and blowing on them until they feel cool again.  Then he perks up and washes himself.  This happens as often as 5 or 6 times a day.  I haven't taken his temp rectally because though I have a lot of experience doing it for other sick buns, he is especially feisty and wouldn't stay in a straitjacket if I had one for him!  The only time I've seen another rabbit overheat like this was in the case of congestive heart failure.  Our regular rabbit vet (whom we use for all our rescues) took a chest ex-ray and said the heart was a normal size, and that she couldn't find anything wrong with him.  Could the head and jaw infections have damaged his heart, and it just hasn't gotten severe enough for it to affect the size of his heart?  He has been heating up even when on the bicillin, and when on the baytril.  If you don't think it's congestive heart failure, what else do you think it could it be?  How could congestive heart failure be diagnosed, aside from a chest x-ray?

2. From what I understand about head abscesses, bicillin is the best way to treat them, and I've read that some head abscess bunnies are kept on it permanently.  Tira Misu has gotten a new abscess every time he's gone off the bicillin, so I'm pretty worried that he's off it now.  I'm worried about putting him back on it, though, because of the digestive upset he was having.  What would you do in this situation?

I appreciate your help with this, Dana.  Tira Misu is a real character, and incredibly resilient, but I think maybe the repeated abscesses are taking a toll on his body.  I'd be grateful for any advice you could offer.

Yours,

Jill Pernicano
Midwest Rabbit Rescue

ANSWER: Dear Jill,

I believe I've already answered this question via another web site:  health@rabbit.org

Please let me know if you didn't receive that response, and I'll send it again.  It would help if you could tell me the subject line you used when you emailed the question to health@rabbit.org

Dana

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

QUESTION: Dear Dana,

Someone else must have asked a similar question, because I didn't even realize HRS had an e-mail address for health-related questions.  This is the first chance I've had to ask this question of anyone.  I thought of you because I know you are very knowledgeable.  If you're able to find your response to the person who e-mailed health@rabbit.org, I'd be interested to read it.  Thanks for your help!  Yours, Jill

Answer
Dear Jill,

Well, that's weird.  Because the email I answered was about a rabbit named Tira Misu, and the person writing it was from Midwest Rabbit Rescue!  And I would swear the question was *verbatim* what you ask here. But I can't find it in my "out" box without an email address, so I'll try my best to duplicate the answer here.

High body temperature can be caused by many things, but the most common is infection.  And unfortunately, you can't really tell the body temperature from the ears.  If they're hot, he's shunting blood to them to cool himself, which is normal, but you can't really know without taking a rectal temperature whether his body temperature is abnormally high.

If you don't think you can manage to take his temperature yourself (instructions can be found at www.bio.miami.edu/hare/sickbun.html ), then I'd have the vet do it, if possible.  It's the only way to get an accurate idea of what's going on.  If this is an intermittent thing, you might be able to ask your vet for a bit of Valium to give him next time he does this, which will make it easier for you to take his temperature.

If he is having fevers, then ask the vet about getting some metacam for him, which will help.  If the fevers are very high, then Banamine is stronger, and you can even put him on ice packs for a while to get his temperature down if it's over 104.  (Lower than that, and I'd let the medications do the job; fevers are part of the "kill the pathogen" response of the body, and you don't want to completely remove that unless there's a chance that a constant, high fever is going to hurt the bunny.)

It might be time to get a new sample of pus (if possible) for a new culture and sensitivity, so you can see whether a different long-acting (rabbit safe) antibiotic might work for this.  Zeniquin (marbofloxacin) might be a good option, especially if combined for a short time with amikacin.  But this will depend on the results of the culture and sensitivity test.

For helping him put on weight (a fever and fighting infection will take its toll; the body burns a lot of calories on this!), you might consider adding a little bit of banana or rolled oats a couple of times a day as a high-calorie supplement, as long as it doesn't upset his GI tract.  Some rabbits are more tolerant of carbs than others, and the only way to know if he is would be to give it a try.

I hope this helps.

Dana