Advice Needed

[KaysieBlum]

About six weeks ago I noticed my almost 5 year old (in March) French Lop, Ralphie, stopped eating so I took him to the vet immediately. When his radiographs came back the vet told me he had eye/nose/ear infection that spread to his lungs causing him to have pneumonia as well. She did a flush and put him on antibiotics. Since then he’s started eating again (and has been eating like crazy!) but when I brought him back for a recheck she noticed him losing still weight (he’s down about 20% since sickness started), despite his eating. She told me his nose/eyes looked clear but that he still had a little infection in his ear. She said what she is still worried about are his lungs. She says since he is eating so heavily and still losing weight, that he has some chronic infection (or even cancer) using all the energy in his body. She continued the antibiotics, prescribed ear drops and sent me home with IV fluids to give him for 10 days. She wants him back to do CT scans and biopsy to give a definitive diagnosis and start what looks like may be surgery to remove an abscess or chemo. 

‘m still very torn about the decision to treat Ralphie with CT scan/biopsy/possible surgery or to just let him live out his life comfortably until he can’t anymore. I don’t know if his chances of recovering from anesthesia/surgery are slim or if he does survive surgery, what his quality of life will be like after. His prognosis seems critical and I know something has to be done soon, one way or another. My instinct is telling me Palliative care may be best but I’m still so unsure because he is active, eating, and even laying with his legs stretched out instead of hunched over. I wish some definitive answer would come to me

Any advice is greatly appreciated.

[LBJ10]

I moved this from the Welcome section to the Q&A section. More people will see it here.

[KaysieBlum]

Thank you! I’m new to this. 

[LBJ10]

Hmm… this is a mystery indeed. But he is still eating, so that is good. As long as he is eating, I guess I don’t see the need to rush into any additional tests. Are the antibiotics new? Or the same kind as the first round? Pneumonia can be difficult to get rid of, so I would understand if the vet wanted to switch if he wasn’t responding well. Otherwise, sometimes it just takes an extra long treatment time.

What is he currently eating? Have you considered supplementing him to help him gain weight?

[KaysieBlum]

Thank you so much for your response!! He is currently on the same antibiotic as before (Enrofloxacin). He was on the antibiotic for 4 weeks and then off for two (mistakenly–I was following the dosage on the bottle instead of prolonging it until I saw the vet again) and now he is back on. He is going to take it until we go back to the vet in 2 weeks so she can test his blood again. 

He is currently eating Oxbow Essentials pellets and Rabbit Hole Hay-Timothy 1st cut. I haven’t considered supplements but that is a good idea. What do you suggest? I’ll check with my vet. Thanks again!

[FlemishDad]

If there is a possible abcess enrofloxacin is not a good choice. It rarely fixes them. The best antibiotic treatment for abcesses is injected bicillin.

Has he been checked for other causes of weight loss like tooth problems or kidney failure? If he is not eating much hay he will lose weight and be very hungry but you might not notice as long as he eats some.

[KaysieBlum]

Thanks for your response! I seriously need all the help I can get. This is what his discharge summary was as of 12/22

Ralphie presented to LSU VTH Zoomed Service for a recheck appointment for his respiratory disease (suspected
Pasteurella), which included ear, nose, and eye infection, as well as pneumonia. Owner reported that Ralphie has been
PU/PD and eating more at home, and is subsequentially forming matted hair and dermatitis under his chin and on his
sternum form the constant moisture. The owner has noticed more caecotrophes in the cage. On physical examination
he was found to be about 5% dehydrated and has lost 10% of his body weight over the last month, and now is at a low
(2/9) body condition score. His nose and eyes were clean and clear, but there was some purulent discharge in his left
ear. We removed some of his matted hair from his chin and rectal area to help prevent further matting and skin
irritation. On his CBC Ralphie was found to have nonregenerative anemia (HCT 29.6%, ref 30-40%), leukopenia (2.2
10^3/uL, ref 5-12), and an inverse heterohile to lymphocyte ratio. Differentials for his presnetation include, but are not
limited to chronic inflammation, infection, and neoplasia. The chemistry profile showed no significant findings, but we
are still concerned about possible renal disease and impaired kidney function. We therefore started fluid therapy.
We recommend follow up diagnostics such as a CT scan with possible ultrasound and FNA or biopsy of the possible
mass in the lungs. At the moment we start Ralphie back on the antibiotic (enrofloxacin) to treat possible infection until a
decision is made on his diagnostics moving forward. We also started antibiotic (ciprofloxacin) drops twice a day to
empirically treat the purulent discharge in his left ear.

Also, to answer your question, I notice him eating more hay now than before. He’s constantly munching and begging for treats. But weight is still low and blood cell/bone marrow count is low so that’s what makes her think it’s a chronic infection. After far as his teeth go, when I brought him in last month the lower left arcade was found to be overgrown with points and was floated to eliminate them. No lesions were found in the oral cavity. A diamond disc was also used to reduce the minimal oblique alignment of the incisors.

[KaysieBlum]

Oh, and I brought up bicillin to her. Her response was that is one of the reasons why she said we need a sample. “I cannot promise that the enrofloxacine is the right drug. However, without doing further diagnostics/having a final diagnose, at this time I do not recommend (and will not prescribe) you another antibiotic – especially since his clinical signs improved. Also anaerobes (bacteria preferring to live without oxygen) are less likely to cause problems in the lungs – which are full of air…” 

[FlemishDad]

Your vet sounds like they know their stuff, which is encouraging.

A comment on drinking and peeing: infections can produce a lot of toxins the kidneys have to get rid of. I am not sure why the vet was concerned about kidney failure since the creatine must have been in normal range. Was it high normal?

If you want Ralphie to gain some weight, you could enrich his diet some by adding rich (for rabbits) food like carrots, squash, and oats. Our rabbit Xavier does have kidney failure and was losing weight. We added some shredded carrots to his veggies and give him a small serving of oats a day and he has gained weight back into the normal range for his breed (Flemish giant).

[LBJ10]

Perhaps the antibiotics were stopped too soon then. If the problem is “simply” pneumonia/URI/ear infection, then his body could still be trying to fight off the infection. You can supplement his diet with a pinch of oats, etc. You can even try a little alfalfa hay on top of his timothy (like a hay topper). Just keep an eye out for poopy butt problems though. If he gets too much rich stuff, it can cause problems back there.

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