Bad liver values

Question
QUESTION: I have a 3.5 month old mini lop. he is the best bunny ever!! He is happy and playful. He has his own cage to eat and sleep in, but is otherwise free in my apartment. I have tried my best to bunny proof it. The problem is that about a month ago i brought him to the vet and we did some bloodwork. The results showed that he has 3 abnormalities: low white blood cells, some bone density issue, and a liver abnormality. I was so hurt. We then did an ultrasound and X-rays. The X-rays showed that his liver is enlarged and when the vet gave him a sedative (only half) he was more out of it than any other bunny the vet has given the sedative to. We gave him Baytril for 11 days, and did bloodwork again. The results were the same as the 1st time. I am so frustrated. He seems very normal and i want to help him but don't know how. Any idea as to what may be wrong? Also, I am scheduled to neuter him tomorrow... is neutering a bad idea? The vet didn't say anything about it. Please help!!

ANSWER: Dear Julie,

If this were my bunny, I would hold off on the neuter until you can get his liver values under control, and figure out what is wrong.  Truthfully, he does not sound like a great surgical candidate at this time, especially if the vet said he was "more out of it than any other rabbit" he'd given that type of sedative.

Although if the vet uses isoflurane it is removed from the body mostly via the lungs, the mere stress of surgery might be more than your bunny should suffer right now.

The low white count can mean many things, but one could be an absces somewhere in his body.  This could cause changes in the liver as well as a sequestering of white cells, as they all travel to the abscess and don't circulate in the bloodstream.

I would maybe find another experienced rabbit vet for a second opinion:

www.rabbit.org/vets

and ask about a course of really serious antibiotics (e.g., bicillin and marbofloxacin for a full month) to see if there is a cryptic infection that might resolve with this.  The vet will know the best course of action.

Also, there is the remote possiblity of hepatic coccidiosis, which is a bit difficult to diagnose.  But this can be treated with ponazuril (expensive, but worth it!).  It might be worth trying if nothing else works.

I hope this gets you on the track to a correct diagnosis and effective treatment.

Dana

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

QUESTION: It was also suggested to me that maybe Marin (1/2 tablet daily), which is for cats and dogs, could increase the values in my bunny. What are your thoughts? Also, to get a second opinion, what would I have to do and say to my current vet?
Thanks again,
Julie

ANSWER: Dear Julie,

Marin is milk thistle extract with other liver support additives.  It can't hurt to try.  I've seen great improvement in the health of babies with liver problems given milk thistle extract.  Might be worth a try!

If you seek a second opinion, you might want to do so confidentially.  You don't want to hurt your original vet's feelings, so go to another vet and get the opinion. If it's the same as what you've already heard, then that's good.  If it's different--you'll have to cross that bridge when it comes.

I hope that helps.

Dana

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

QUESTION: Thank you for being so patient. Seems like my vet wants to test him for E Cuniculi... because I guess it's not only his liver that is week... his kidneys are effected too. Anyway, I cancelled his neutering and the vet tells me that she spoke to a specialist who said that there shouldn't be a problem to give him anesthesia. I said that we should hold off with the neutering until we get the results for E Cuniculi. Do you think getting this test done is as effective as getting a test done for Hepatic Coccidiosis? Thanks again.

Answer
Dear Julie,

If the vet wants to take blood for a paired titer test to see if your bunny has been exposed to E. cuniculi, I guess that's fine.  It won't necessarily tell whether he has an active infection, but it can say whether he's been exposed.  (Paired titer tests are iffy, diagnostically...)

We no longer test for E. cuniculi.  If we suspect a bunny has the parasite, then we treat for 28 days with Panacur (fenbendazole), which has proven quite safe and often effective, depending on the level of the bunny's infection and the general health of the bunny's own immune system.

It is very difficult to diagnose hepatic coccidiosis.  If the vet suspects it, then I would ask about treating with  ponazuril as a precaution.  We have absolutely incredible results with this drug for intestinal coccidiosis.

If you're not sure your vet is going the way that's best for your bunny, I'd think about getting a second opinion from another rabbit-savvy vet:

www.rabbit.org/vets

Hope he'll be on the mend soon!
Dana