metacam dosages and anesthetic risks

Question
QUESTION: Hi Dana,

Following up from my last post to you regarding my elder rabbit Pepsi who's nearly 10 yrs old now.  To recap she has regular filings on her molars which have recently become more frequent.

My first question is what is the safe upper dosage I can give to Pepsi for pain relief using Metacam.  She weighs 1.5 kg and my vet tells me I can only give her one drop every 12 hours maximum otherwise there is risk of stomach ulcers.  I have questioned the dosage as it seems ineffective and she definitely needs pain relief for a few days after dentals.  I've read that plenty of people give much higher dosages than this to their rabbits and some are on it long term for various illnesses.  Is there really that much a risk to increase so that it gives her proper relief?  If this really isn't possible, is there any other pain relief I could give her without so much associated risk?

My other concern now is as she gets older, I was wondering how much repeated anesthetics are to her health.
My vets have been using injectable anaesthetics and so far she has been ok with this, but do they affect her organs in any way if she's having them on average every 4 weeks, would there be less side affects from Isofluorane gas?  I was even wondering as I have heard some rabbits have filings done by using sedation and a muscle relaxant.  I would consider Pepsi for this if I thought it was a successful alternative way for her, to save her going through repeated full anaesthetics.  As my current vets are using slow speed drill to do the burring there seem reluctant to do any other way, but as you mentioned previously that you use a revlon nail file, can this be used to do the top and bottom teeth, even if teeth are quite long.

Finally, was wondering how low the teeth should be filed to and should all teeth be done, not just the spurs for better chance of re-alignment?  My vets have been filing the lower teeth to just above the gumline, but have been taking the lower teeth low to try and increase time between filings.

Thanks so much, all advice much appreciated

Sue and Pepsi

ANSWER: Dear Sue,

Carpenter's Exotic Formulary has a reference for 0.1-0.2 mg/kg of metacam by mouth once every 24 hours.  I know of people who go as high as 0.3mg/kg that often.  There are some who claim that metacam is a COX-2 inhibitor, which would mean that the risk of stomach ulceration is lower than with some other NSAIDS (such as flunixin meglumine--Banamine), but the jury's still out on that.  But if your vet is worried about the bunny's stomach, then why not ask about dosing the bunny with famotidine (an antacid) along with the metacam?  That should prevent any problems with a higher, more effective dose.

Please also ask about combining tramadol with metacam.  We find that this is *fantastic* for controlling pain, and the bunny feels great.  

Anesthesia is never without risk, and the older a bunny is, the more risky things become as the systems start to "wear out."  But molar spurs are painful, and must be dealt with.

This is going to sound weird, but I've actually learned to file lingual spurs (on the mandible) myself, without anesthesia.  The upper (usually buccal--pointing into the cheek) spurs are more difficult, but also slower to develop.  I wonder if you could ask your vet whether the filings might be done under *sedation*, rather than full anesthesia, which would be much less risky.  It depends on the personality of the rabbit and the expertise/experience of the vet.  But yes, we do stick to the Revlon file if the bunny isn't fully asleep, for obvious reasons.

Are all her teeth misaligned, including her incisors?  If it's just the molars, we don't take the tooth down at all.  Just the spurs, leaving the teeth where they are.  This seems to allow normal chewing and better wear for at least a few months.

It will also help to let her graze on natural grass (no pesticides or fertilizers, obviously), since the motion this promotes, as well as the texture, works even better than hay to keep spurs at bay.  We have several outdoor rabbits, and one who has the worst malocclusion of molars the vet has ever seen.  But because she eats grass and sticks every day, she hasn't needed a filing for a couple of years!

I hope some of this helps!  Congratulations on getting Pepsi to such a great age!  Here's hoping she gives you nine *more* loving years.

Dana



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

QUESTION: Hi Dana,

Thanks for all the advice regarding the pain relief and anesthesia for Pepsi.  I am very keen to find out how rabbits cope with just beind sedated like you say.  It seems Pepsi would benefit better from a light filing every 2-3 weeks when her teeth start affecting her eating again from a previous dental, instead of heavier burring and full anaesthetic.  I was just wondering what technique you use when you do your filings.  How do you hold them, do most rabbits tolerate filings ok then without the anaesthesia?  I also read that a muscle relaxant may help too, have you tried this and do you know name of any that may help?  ( It is only Pepsi's molars affected by the way, incisors are fine)  They tell me Pepsi's teeth grow very quick, but the pictures I've seen of her x-rays don't look as bad as a lot of rabbits with really bad maloclusion, so just not sure the burring is the right way to manage it any more.  They did find a loose upper molar on her last dental and that has just been extraced also.
Is it just the spurs that stop them eating then, not the fact that the teeth grow long, when my rabbits go in they tell me that various teeth have grown long and also some quite spikey.

On a separate issue Pepsi was found to have a small bladder stone also last time she was in for a dental.  The vet said it was 'likely insignificant' though and as she's not displaying any signs of a urinary tract infection that there's no need to be concerned about this at present.  I am concerned about it growing though and wondered if we shouldn't be looking at doing anything on the preventative side rather than waiting for a problem to happen.  Will this need to be monitored regulary- if so, how often.  Would a bladder flush be helpful,if so,what does this entail, or would sub-q fluids be helpful at this point. Have also read about Polycitra K breaking up stones, but don't know much about this being used in rabbits. Am I worrying unnecessarily if my vet thinks this is not a concern at the moment.

Sorry so many questions, would sure appreciate a second opinion on this bladder stone issue though and the dental advice you are giving has been so helpful for me.

Many thanks


Sue and Pepsi  

Answer
Dear Sue,

I'm the only person I know who does molar filings without anesthesia, and I would not recommend it if I can't show you in person how it's done.  Light anesthesia may allow your own vet to trance Pepsi, open her mouth or even insert a Revlon nail file into the mouth and file molars "by feel."  I check for spurs with an otoscope, and then file by feel.  Crazy, but it works.

But as I said before, it's nearly impossible to do buccal spurs.  This works only on lingual ones on the mandible.  It's not hard once you learn how, but I really can't even begin to explain via email, and would not want to be responsible if you tried and ended up hurting Pepsi.  :(

Bladder stones are problematic.  I do know of some people who have used Polycitra  successfully, but I don't know the dose.  A bladder flush will not likely help, since the stone is already probably too big to pass through the urethra.  The only way to remove a stone of any size is via cystotomy:  surgery to remove the stone from the bladder.

Since the vet says the stone isn't big enough to worry about now, I'd wait and see if it does get bigger.  Maybe ask about trying Polycitra, too.  If it does get bigger, you can consider surgery then.  And unfortunately, uroliths do tend to have a recurrence likelihood, though none of the bunnies I've had with them have ever gotten them again, once they were surgically removed.

Hope this helps!

Dana