Any Osteomyelitis experiences? Advice needed

[puffs-of-fluff]

Hi everyone, This is long but my bunny’s life is hanging in the balance at the moment, so please take time to read and give me your experiences and advice

I’ve previously posted a little bit about this when asking for Vet recommendations. https://binkybunny.com/FORUM/tabid/54/aft/162945/Default.aspx

But the situation has moved on a bit since then, and a diagnosis has been made, so thought I would start a new thread, as it has turned out that it’s a bit passed the stage of looking for another surgeon. (And i have just stopped crying long enough to write a post)

The CT scan results have come back and shown extensive osteomyelitis (Abscess in the bone) in the lower left mandible BOTH lateral (side of the cheek) and medial (side of the tongue), as well as underneath the chin. The infection has also started to spread to the right side mandible, as that is also showing the beginning of infection. I have been told (by a specialist vet) that her abscess is inoperable, as there are too many structures involved, including infected tissue surrounding the carotid artery.  There are 5 teeth involved at the moment (left molars 3, 4,5 and right molars 4, 5), but they are unsure if the infection started in these, or in the bone itself, as this extensive damage has popped up just 3 weeks after they looked in her mouth and everything was fine. I have been advised to have her pts, but refuse to give up just yet, as I feel we have tried nothing! She has so much more life left to live. She’s not even 4. This isn’t fair, she’s too loved.

Her current health issues in the last few days is as follows:

1. Stopped eating by herself, but is eating soaked pellets offered to her in small amounts and is being syringe fed organic baby food smoothies. No longer is able to eat any hay (has not done so for about 10 days) and in the last 3 days has also stopped eating veggies (she was trying, but was unable to chew them).

2. Stopped drinking by herself, from a bottle or bowl (potentially because of the constant wet fur around her mouth annoying her), Is being force fed water from syringe, or will sip from a syringe herself when i mix some apple juice in the water,

3. Smells awful. Her breath and her fur around her mouth smell completely rotten. The vet thinks its her saliva and cannot see evidence of the abscess bursting.

4. Is snoring and whimpering when breathing. Mainly when relaxed or stressed. Seems quieter when neutral.

5. Has lost 300 grams since May (but has put on 70 grams in the last week thanks to my boyfriend and I syringe feeding like mad)

The vet has agreed to try antibiotics, but has told me that this won’t cure her and will be a palliative treatment only. However, i am sure that i have read success stories on here of long term antibiotic success in keeping abscesses and osteomyelitis at bay. I really want to hear your experiences.

Her current medications are:

Depocillin – 0.25ml injection x1 daily

Metacam 12kg  x2 daily

Tramadol – 0,18ml 1x daily

Rinitidine 0.5mg 3x daily

Metronidazol oral 0.9ml – 2x daily 

probiotic with food

Please tell me anything you can to help, any advice you have about the smell of her breath and mouth fur, or any disagreements with dosage. Also, would love to hear some success stories (and when did you start to see an improvement)

Ethel and I thank you xxx

[puffs-of-fluff]

Update

She has eaten some dried pellets on her own and has even had a tiny bit of kale for the first time in over a week. I’m still giving her the soaked pellets as it’s a good way of getting water in her. Still no chance of eating hay, I think its just too painful. I’m not sure if this means that the depocillin is working, or if it’s because the vet upped her pain meds? Does anyone have any experience of how long the depocillin takes to make an improvement?

She is getting a bit more difficult to give meds to, struggling more and nibbling my clothes. I think this might be a good sign, as she is less listless. She usually behaves like this when restrained, so it was horrible to see her so docile and tired.

The snoring has got a lot worse, i can hear the fluid moving in her nose, sounds like she is full of cold. I’m not sure why she would even be snoring, the abscess is on the lower jaw. The vet said there was fluid in her nasal cavity on the CT, but said it wasn’t an abscess. Can anyone explain why this would be? Is it just inflammation?

The abscess is much bigger than the last time i felt it a week ago (I try not to prod it because it’s painful for her, and I’m prodding her enough with meds). It’s obviously not been lanced, drained or removed because of the complications, but does anyone know if the depocillin is supposed to make this shrink, or will it just work to stop it getting bigger and reduce the infection in the bone and surrounding tissue?

My hope with the depocillin is that it controls and reduces the infection enough to improve her breathing, eating and drinking, and puts her in a better position to have the abscess lanced and drained, and the molar teeth removed. My vet says she hates the impregnated beads, as its another operation to remove them, else they swallow them (which is apparently dangerous?), and says there is little evidence they work anyway. However, i’ve seen quite a lot of support for them on here, so interested to know what you all think. I think my vet’s point is that the osteomyelitis is too extensive, and they would only prevent an abscess popping back up in the area that she places them, so one would pop up elsewhere. She doesn’t believe she will be able to remove all of the necrotic tissue from the bone anyway, and says that they can’t do jaw replacements on rabbits (like they do in dogs and cats) due to their teeth. Again, any experience?

Please someone help

[LBJ10]

This is what MediRabbit has to say:

If osteomyelitis, its extension in the jaw bone must be assessed. If the infection spreads over a few molars, prognosis is guarded and the option of humanely putting the rabbit to sleep should be considered. Treatment includes the administration of systemic antibiotics that penetrate the bone, chosen according to the results obtained from the bacterial culture and antibiotic sensitivity tests. The choice of antibiotics safe to use in rabbits is limited. The treatment must be aggressive and long, between 4 to 6 weeks. If the antibiotics fails to reduce the infection, or bone has been destroyed, surgical debridement should be considered.

Depocillin is the same as Pen G. This seems reasonable. How long does the vet plan to continue the injections? To answer your question, the injections may or may not reduce the size of the abscess. The hope is that they will reduce the infection enough that the area can be opened and cleaned thoroughly to get rid of any remaining infection.

As far as the snuffiness goes, it could be bacteria that has spread to the sinuses or it could be inflammation of the area. It’s hard to know. I would think that if it was bacteria, that it would start to clear up with the antibiotic treatment.

Other than that, I don’t have anything else to offer. I have no personal experience with this. There have been some members here with similar experiences, but many of them did not have a positive outcome. I’m sorry you’re having to go through this with your bunny. I hope the treatment she is receiving will reduce the infection.

[puffs-of-fluff]

Thanks for replying. I think the vet plans to continue the injections indefinitely, depending on whether or not an improvement is made. We were unable to do a culture and sensitivity test because of the placement of the abscess, and she said it would do more harm that good if we weren’t removing it completely, as it may spread the infection further. The same reason was given for not removing her teeth (as well as possibly not being able to get to them through the mouth, and the cheek is compromised). So we are seeing what the antibiotics do, hoping, as you said, that it will reduce some of the infection enough to operate (and we know that they will control the spread of infection then before we risk it).

I really hope that someone with experience of this reads this thread soon, as could do with some real life input, and really keen to know what effects I should be seeing from the meds and when. If there is anyone you can think of, please point them my way. Thanks

I am aware that this is going to be a lifelong battle, and she is always going to be a dental bun and struggle with abscesses, but I’m willing to give her the special care she needs, and I know she’s got fight in her. I’m sadly aware that she’s not going to live til the ripe age of 15, but 4 is so young to go, and I want to see her binky and play again. Would love to give her a few more years

[jerseygirl]

Im really sorry things progressed as quickly as they have. It does sound pretty extensive. And yes, it is grossly unfair. Sending {{{{{Vibes}}} to your Ethel bunny. Im sure she is feeling the love from you and your boyfriend.
There is 2 in your profile pic. Does she have a bondmate also?

My own experience with abscess in rabbits were one that came up on the lower jaw and, more recently, a facial abscess that affected structures of the ear. With those, I was able to have them put under to have the abscess cleaned out. I don’t say drained as rabbit pus cannot be drained. It is thick and has to be scraped out, including the outer wall / abscess capsule. Some bone also need to be curetted. I think this is routinely done even if bone appears healthy?? Osteomylitis wasn’t confirmed in either case. 

These abscesses be incredibly destructive and form finger-like extensions into new areas. So removing it all is difficult also. Once removed, it is then this balancing act of keeping on top of infection using antibiotics. I used dual antibiotics also. Penicillin and metronidazole for Jelly, my rabbit (he is now passed away). Injectable penicillin is essential, in my view. I do not think antibiotics alone will help reduce an abscess in this area. I’m sorry to say. 

Gooseman had treatment for facial abscess Jan 2016. The vet initially thought it was a tumor going by the x-ray but abscess hadn’t been ruled out. I opted to have him go in surgically to look. The vet ended up removing lots of pus and scraping back bone where the abscess and bone had met. The site was left partially open so I could flush it out daily until it heal from the inside out.  

He’s been left with permanent damage and I cannot say this is fully resolved. Ive recently had him in to have pus removed from his other ear and he’s having ear drops.  Ive also discovered a suspicious lump on that side of his face which will be x-rayed soon to see what’s going on. I suspect it’s similar to what happened on his right side. : (   

Regarding pain management, what weight is Ethel? I think your vet has covered a lot of bases giving dual antibiotics and dual pain meds. And ranitidine to protect the gut, I assume?
 If the vet started out with conservative doses of the metacam and tramadol, you might be able to review it with them and increase doses. My understanding is that infections like this are very painful, so managing this is key. If you don’t think she is tolerating one or the other, an alternative may be needed. Keep communicating with your vet.

My elderly rabbit is on 10kg dog dose of metacam x2 daily. This is 0.66ml of metacam (1.5mg/ml strength) each time. So he is getting 0.5mg/kg 12 hourly. That is within the recommended dosage range but it is known that rabbits can tolerate doses of 1-1.5mg/kg without it accumulating as the metabolise it much faster then cats and dogs.
Having said that, some rabbits tolerate some pain meds better then others, so it’s a matter of working with your vet to find the right combo for the individual rabbit.

p.s. Sorry about the bolded parts. Just wanted to be clear with ml’s verses mg. It can get super confusing when meloxicam syringes are marked in KG (or Lbs) for cats and dogs, then working out what that actually is in mls. 

[puffs-of-fluff]

Yes, she has a husband! Gussy. He is currently being a bit of pain because he is so bored bless him. She doesn’t want to play, and just lies in the hallway all day. So he is just running around under my feet, nipping me for attention (and then running away if i try to give it to him because he has never been a lap bunny) and just chinning everything in the house (I think he feels like the alpha now). But in general, everything is fine with him and I’m not worried about him. Although I don’t know how he will cope if anything happens to her. I always say that Ethel is my bunny, and he is hers.

Ethel is 1.95kg now, she did drop down to 1.88kg – but we have been vigilant with syringe feeding the last 2 weeks. Prior to this, she was 2.20kg. I think she seems to be tolerating the meds quite well at the moment, but I will be keeping an eye. For the first time in 2 weeks, she begged for some treats yesterday (they are called Niblots; crunchy things with pureed carrot in the centre). She wolfed down 5 of these. I was amazed. So I really do think that there is some reduction of swelling going on.

I feel the same as you about the metacam syringe, I haven’t worked it out. All i know is that she is on 12kg dose, 2x daily. So 24kg altogether

May I ask how long Jelly lived for with abscesses? And how often did they come back? And Gooseman, how often has he been struggling with abscesses? And have either of them ever had the anti-biotic beads?

I was thinking earlier, I’m not sure how many other bunnies actually have had such in depth scans as Ethel has. So it is quite possible that a lot of buns talked about on here have osteomyelitis with their abscesses, but the owners don’t know about it. Ethel’s did not show up clearly on the x-ray, it’s only because she has had a CT that they are saying how extensive it is. Maybe that is why a lot of abscesses are difficult to treat and keep coming back – because it’s more in the bones than we realise. Maybe her prognosis is no worse than some other buns with abscesses, and if we can get her into surgery, she stands the same chance of at least controlling it? Or is this just wishful thinking?

[jerseygirl]

I was thinking earlier, I’m not sure how many other bunnies actually have had such in depth scans as Ethel has. So it is quite possible that a lot of buns talked about on here have osteomyelitis with their abscesses, but the owners don’t know about it. Ethel’s did not show up clearly on the x-ray, it’s only because she has had a CT that they are saying how extensive it is. Maybe that is why a lot of abscesses are difficult to treat and keep coming back – because it’s more in the bones than we realise. Maybe her prognosis is no worse than some other buns with abscesses, and if we can get her into surgery, she stands the same chance of at least controlling it? Or is this just wishful thinking?

Good point about the CT scan. Very possible many don’t know the true extent of what they dealing with. I know that was/is the case for me, really. CT wasn’t something the vets Id seen could offer and they didn’t really give me the impression that having it done elsewhere would change the situation. I often feel a bit lost on what approach to take. It’s a learning experience, for sure. I did push for having an abscess opened though, when possible.

May I ask how long Jelly lived for with abscesses? And how often did they come back? And Gooseman, how often has he been struggling with abscesses? And have either of them ever had the anti-biotic beads?

Ah, Jelly… Well, he didn’t reach 2 years of age.  I had to have him euthanised. It wasn’t the jaw abscess the reason for that though. He was actually having a good run with that issue. But he became ill with an acute gastrointestinal complaint. I don’t even know what to call it. At the time I thought mucoid enteritis after a prolonged bout of gut stasis. Basically, he lost a heap of weight and was in pain and I felt like he was dying. It’s a bit hard to talk about as I feel I should have managed it all better and I think there was one point at the vet where he was giving appropriate care due to the less rabbit savvy vets being the only in attendence. Benefit of hindsight, I guess.
He didn’t get very good genes. I took him in as a young rabbit and someone else I knew took in his brother. They were told the brother had dental issues and that proved to be true. He didn’t live a long life either. Jelly had cataracts (possibly from birth) but these didn’t appear to hinder him. He also ate well even when the jaw abscess popped up. I had it opened twice. The second time, it wasn’t opened as extensively and closed up to fast for me to keep flushing it out. Then one afternoon I noticed it swelling again. I made an appointment for next day and would have asked they open it again. But overnight, it swelled up more I found him in the morning with it burst open. He was fine, waiting for his brekky! I actually gave me the chance to flush it all out and after his appointment, I continued to do that until it closed again. So although gross, it actually was for the best because it got everything out. I know months passed after that where the abscess didn’t reoccur. I cannot say how long that would have lasted because he fell ill. Ive often wondered if his illness could have been related, if perhaps there was still infection going on unseen and he became septic? But it’s all just speculation. As I said, he didn’t get the best genes in life. Despite his health issues he was lovely and a lap bunny too. I was spoilt.

I cannot say confidently if that one is resolved. Ive always been aware that recurrence is likely.. He only ever had xray, then surgery for the abscess, no CT. Were there a tumour, or infection in bone like was initally speculated, I can’t see how he could have gone this past 18 months as healthy as he has been.

I am looking to have him sedated soon to have xrays done of that side but also to see what is happening on the other side. The lump I mentioned is less prominent since the ear has been treated this last 3 weeks. The vet said maybe due to reduction of pressure. But Im a bit suspicious that this one might be around a molar root.

I’ll need to ask the vet if antibiotic beads are an option now. Back at the time with Jelly, the bicillin beads were not available here.
Interstate, there are some clinics that specialise in rabbits and guinea pigs only. I have some friends that have become friends with a few of the vets through their work for an animal sanctuary. So Im thinking about having them ask for me about what sort of options are available now.

You sound as if you’ve already consulted with very rabbit savvy vets for Ethel. She is in good hands with you and them. It is so good to read how enthusiatic she was for those treats! I hope she continues to have a good appetite and remain comfortable. Just take things day by day.

[puffs-of-fluff]

Poor Jelly I don’t know how people cope with losing their pets.

Please keep me updated how your other bun is doing. Would be interested to hear what your vet says about the beads. Fingers crossed for you

I have some updates on Ethel. All seems to be going scarily well. Her appetite has increased a lot (or moreover, she is able to indulge it!). She is eating faster, back on solid pellets completely, and is now eating a huge portion of greens every evening. She is begging for food more often (i’m guessing she is more hungry than usual as she still can’t eat hay) and even ran over to me for her breakfast this morning for the first time in ages. She is moving around more, doing flops and even jumped on my bed last night. I was amazed. She also pulled everything out of my wardrobe yesterday (mainly gumming everything, as i don;t think she has got much power in her teeth to gnaw hard). Still no binkies yet, that’s what i’m waiting for! I can’t believe that a week ago I was being encourgaed to have her PTS. I’m so glad that i stuck to my guns.

She is still snorting like a little piggy when she eats or grooms herself (she is doing that again now which is a relief, as there was so much mess on her face from where she was dribbling). And weirdly, she still isn’t drinking by herself. I’m loathe not to syringe her water every morning and night, in case she goes into stasis like she nearly did before, but maybe she isn’t trying to drink because she isn’t thirsty after that? I’m only giving her about 15 ml a day though (the additional water soaked veggies). How much do your buns drink?

I don’t want to be deluded about the situation, but i swear the lump in her jaw is getting smaller? Am I crazy?

The question is now what to do in the future. She is obviously responding to the depocillin in some way, but if the abscess truly is shrinking, should i still be looking to open it up? And do I really want her teeth removed if this could spread the infection? I’m thinking that an x-ray and examination would be a good idea, but I supposed they will have to operate during if they see anything to be done, as don’t want her going under more than necessary.

The main thing i am panicking about this morning is that I gave her the depocilin shot earlier, and must have gone through all of the skin that I pinched, not under it. As when I looked down, there was penicillin dripping all over my leg and her paw. I washed it off as thoroughly as i could (difficult to see on white fur), but was really worried, as it couldn’t have gone in a worse place (the first thing she did was groom her damp paw). I called the vet and she said not to worry too much, but it was a lot of it and I am worried I’ve messed everything up. The other dilemma is that I had no idea if any penicillin has actually stayed in her, so I had to give her the shot again (full dose). So I hope a little extra won’t hurt her if that is the case. Feeling really un-confident at giving these shots now, and worried I’ve hurt my baby.

I’m not sure how much longer I can continue with her prognosis being so unclear too. I’m not sleeping, can’t stop watching her every movement, am up til late googling what I can do to fix her. My boyfriend is getting stressed with how anxious I’m being about her (and for him having to travel to my house every time now, as I can’t leave her (needing meds 3x day) and can’t travel the 45 minute drive with her penicillin). I feel burned out. I know you all feel like that when nursing a sick bun too, but I just feel like there is no end in sight where I can have a life too, but I’m so desperate to keep her alive and well. I wan’t the vet to tell me that we can reduce her meds, but at the same time, can’t bear to think about reducing her meds in case she gets worse again. Arghhhhh

[puffs-of-fluff]

This thread didn’t really take off the way I was hoping, which is a shame because I didn’t find much real life experience of osteomyelitis when I was searching forums. I was hoping it would be a good thread for other people in this situation to read in the future, as I know it is a very stressful situation. Regardless, I thought i would give an update just for anyone searching in the future to read.

When i took Ethel to the vet, they were surprised at how well she had responded to the depocillin injections. My vet said that 2 things had happened, which kind of changed the game. Firstly, the anti-biotics had brought down the swelling in her jaw/gums, which is why she began eating better. Secondly, the lack of swelling in the gums meant that the abscess started growing outwards – and actually ended up splitting the cheek muscle. This sounds awful, but it meant that they could access it without the complications of the vessels and nerves in that muscle causing too much risk. So she went in for the operation on Thursday. She had 3 teeth on the left side removed, the bone debrided as much as possible, and the abscess lanced and drained. Apparently there was a small problem intubating her, as her throat was very swollen (they are unsure why), but they managed eventually.

She returned home the same day, as woke up well. She was very unhappy the first 2 days, barely eating (syringe fed day 1), but then brightened up and has been wonderful.

It’s now tuesday. I have to flush the wound 2xday and pack it with manukha honey (ethel hates this process and i know it hurts her, but we manage just the 2 of us in a bunny burritto). She’s still on depocillin daily, and will need for the wound to stay open 3 weeks. Then we will have a review. I am managing to keep the wound open really well so far, so I’m feeling hopeful. Still feeling burned out, but she needs me.

And I am pleased to report that she did her first binky in 2 months this evening.

I am very glad i persevered with this and didn’t put my baby to sleep.

We may have a long way to go, but she is alive and well.

[LBJ10]

Thank you for the update! I’m glad to hear she is progressing and things are going well.

[jerseygirl]

Yes, thanks so much for the update. Ive been wondering how she is doing and am really pleased to read things have turned for the better! That is so interesting how the abscess moved outward. When Jelly’s burst, it was a blessing in disguise in a way.

Without the pressure there now, Ethel must be feeling so much better.
The honey is great at really keeping the cavity clean and ridding of any pus. I hope you are seeing that.

Im sorry I havent gotten back to you about quizzing my vet about antibiotic beads. I hadn’t taken Goose back in as planned as his bond mate became ill so I took her in place of him for the appt I had scheduled.

[Author]

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