How can I help Teddy?

[Meg]

Hey everyone, happy new year!

So Teddy, our 13 1/2-year-old Lionhead, has been eating super well the last 7 months since his arthritis caught up to him and he lost mobility.  (He’s not paralyzed, he just can’t hop.)  His appetite has even been stronger than the previous few years, and he’s been drinking water out of a bowl a couple times a day for the last few months.  His tummy feels way less supple even on good days with no symptoms — not sure if that’s old age or if he’s dehydrated or if somehow his metabolism is up and we’re not getting enough calories in him despite all the eating?

But anyway, things have been different the past few days since my partner had to leave for a 10-day trip.  (Normally we trade off so I stay up super late and he gets up earlier, so that Teddy gets care/attention from my partner about 4 hours after I put him to bed.)

At first, he was just slower to eat the medicines off his morning plate.  Then he had a couple of brief spells (an hour or less) of not wanting food/treats (this has not happened in quite a while).  He’s also seemed a bit sleepier.  Last night, after midnight, he stopped eating/accepting food for a couple of hours, and he only took a few licks of his nighttime medicine plate — I had to manipulate him to finish it by holding it in front of his face while I groomed his ears until he had the licking response.   (I felt like a jerk, but it seemed less stressful for him than oral syringe feeding the meds.)  Then I noticed that he had some dried medicine and stuff stuck in the fur around his mouth, so we spent some time grooming that, with me using a water spray bottle and letting him lick his fur, and he seemed happier.  He was sniffing his food right at bedtime, though I’m not 100% sure he didn’t just rearrange it overnight (it doesn’t look like he ate much — hard to tell if he definitely ate anything.)  We’ve been through GI stasis many times in the past, and this doesn’t seem like that, because he doesn’t show any other signs of GI discomfort, and he does a lot of licking and tooth purring.  And his appetite has been quite variable (sometimes strong).

So this morning I woke up after a few hours’ sleep and went to check on him.  He seemed relaxed, but refused all treats/food/water except a few bites of banana.  Whenever I offered something, he would make this sound that was neither a tooth purring nor obviously a pain-grinding — it looked and sounded like he was chewing pellets, but he wasn’t eating anything.  I took this to be maybe a new form of pain-grinding (??) and we’ve had more of the grooming around his face and me squirting water (trying to get him to drink as much of it as possible).  He seems happy (lots of licking) and hasn’t made any more tooth sounds other than a bit of normal purring.  But he still won’t eat anything but banana (I’ve just let him have a few tiny nibbles and will keep it minimal since I don’t want to cause dysbiosis).

He was last examined by our bunny vet 3.5 months ago, and they weren’t worried about his teeth, but now I am wondering if this is a tooth pain thing, or something else? It’s a holiday here so I’m wondering what I can do while the vets are closed.  I do have fresh Lactated Ringer’s here so I will probably give that in a few hours if he doesn’t turn around.  (What I don’t have is a clean line — one will arrive tomorrow, and if I need one today I will try to learn how to flush an old one of his to make it as fresh/clean as possible?)  He gets meloxicam, cisapride and simethicone twice daily, and last had it 7 hours ago, so I will keep that up about every 12 hours.  And then of course Critical Care if he still won’t eat (but he haaaates that, poor bun!  No mix-ins have ever changed his mind about that).  Is there anything else I could be doing to help him? I love him sooo much.

Thank you!!

 

p.s. Update: he’s now eating a few dried leaves (willow and plantain).  It’s not much, but it’s nice to hear him crunching something.

[Heatherar]

Is his mouth wet ? Like drooling ? Maybe he’s feeling off . I would take him to the vet so they can check his teeth . Is he eating hay at least ? Water ?

[Bam]

I’m glad he’s eating something!

I think moderator Dana gives her elderbun Emeraid instead of Critical Care, and that Emeraid is a lot better liked by her buns. I have never used Emeraid myself, but it seems like a really great product. There are both a herbivore intensive care formula and a herbivore sustain formula.

I have never cleaned a line either. I hope someone else her can tell you how to best go about it.

Hoppy New Year to you and Teddy 💝

[Heatherar]

That’s good to hear he’s eating something !!!!

[DanaNM]

It’s really hard to know what to do in this situation. How is he doing now? With Bun Jovi, I’ve personally decided not to do any extreme procedures or interventions with him if he starts declining rapidly. But, that doesn’t mean I won’t try basic things!

I do recommend trying Emeraid (herbivore Sustain formula). Bun Jovi loves it, and I’m sure that it has literally kept him alive. Arthritis can affect the jaw as well, so his hay consumption isn’t what it used to be. It’s sold by several online retailers with fast shipping! I also think some fluids wouldn’t hurt.

It’s also worth looking at his pain management. He could need to go up (or even down). We increased BJ’s tramadol too fast and it caused his appetite to drop. Teddy may have maxed out on metacam but could do well with adding tramadol into his daily meds. It really helped Bun Jovi.

Of course he could have a spur (the mouth movements suggest that), but doing a dental on Teddy at this point would be risky and maybe not worth it if you can get him to eat some mush food.

(((Teddy)))

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[Meg]

Thank you so much, everyone!  I’m excited to try Emeraid, and have just ordered some of the Sustain kind (it should arrive on Friday).  Teddy hasn’t been into the Sherwood or American Pet Diner versions of CC either, but maybe Emeraid will be the one!  🙂  Thank you so much for telling me.  🙂  I didn’t realize about how arthritis affects the jaw too — that could totally explain why Teddy’s been so much less into hay!  I know he needs it and pellets don’t provide enough fiber, but on the other hand he’s so skinny, he needs to put on weight and keep it on, so I haven’t been sure what to do.  Maybe Emeraid can help.

That’s a good point about pain management, Dana.  You’re right, Teddy’s still getting a ton of meloxicam, but good point to ask his vet about adding Tramadol if he still seems painful.  (Seeing how stiff he is, and how earlier he would be interested in sniffing food but then not bite into it, I’m not thinking his pain meds should be reduced.)

Thankfully, Teddy’s been doing better this afternoon/evening so far (knock on wood).  No more weird tooths sounds/movements, and he’s been acting and eating more normally.  (He was never drooling.)  He ate most of his next medicine plate willingly (and finished the last part during his ear grooming times).  Then he ate 2/3 of a basil plant and some pellets on his own initiative.  He’s also napping a bit and stretched out like usual (seems pretty physically comfortable, or at least sleepy).  So at least for the moment, his behavior/eating is much closer to normal, and I’m really grateful.

I couldn’t find any directions for cleaning the line, because it’s just not recommended.  At this point, I feel like the risks might outweigh the benefits of using a months-old used line vs. waiting for a new one to arrive tomorrow, so I think I will hold off as long as he seems pretty OK.

Finally, I take your point about how risky dental work could be at this stage.  Past vets have been able to do a quick trim/filing without putting him under, but this vet says they would need to put him under for it and that’s the part that makes me the most nervous.  Let’s see how things unfold.

Thank you so much for your advice and moral support!  I can’t tell you how much I appreciate it.  <3  My partner is on the other side of the globe right now to scatter his mother’s ashes in her home country (after she passed away prematurely), and he will be away for another week.  So for him, for Teddy, and for myself, I want to do all I can to help Teddy get better.  We both love him soooo much!!

[DanaNM]

I hope he likes the Emeraid and I’ve glad he perked up a bit! Aside from my own experience, I’ve been hearing good reviews on it on facebook in the Elderbuns group as well as from friends from the rescue.

I’m sorry about your partner’s mom. 🙁 <3

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[Meg]

Thank you so much, Dana!!  Thanks for your kind words too.

I’m so thankful for the Emeraid recommendation!  Thankfully Teddy seems basically himself again the past couple of days — woohooo!  He’s eating his normal pellets again and has a good appetite, so am I right to think we should hold off on the Emeraid until he has trouble with his regular food?  Or would it be good to add it as a supplement at this stage?

Thank you so much again!  🙂

[DanaNM]

That’s great his eating is back to normal! I don’t think there’s any harm in offering him some to see if he likes it, but totally up to you! The sustain formula can be used as a regular supplement for seniors or other buns that might need a bit more nutrition.

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[Bam]

Oh, wonderful!

As Dana said, you can offer the Emeraid as a daily supplement. It wont do any harm, but it could give his precious elderbunny self much needed energy and lust for life. I’m delighted that he seems to enjoy it! I hope this product will come to my far off little country eventually.

[LBJ10]

I’m glad to hear he has perked up again! 🙂

[Meg]

Thank you so much, everyone!  Teddy was doing stellar until today, when he was more similar to last Sunday.  Not as bad off and not necessarily doing the tooth grinding thing (but maybe? at one point it was hard to tell if he was doing that or actually chewing), and he’s now started eating a little more (kale and pellets) on his own, so I’m gonna see how things go.  My partner just got back a few hours ago from his trip, and I’m hoping that getting back into his normal routine where Teddy only has to go about 4 hours without attention will help his physical comfort and morale.  (Last night he had to be in the exact same spot for 9 hours while I slept — he had food, plush friends, and absorbent bedding, but no way to move or really entertain himself, and that’s got to be a bummer, not to mention tough with arthritis.)

Unfortunately, he has rejected the Emeraid so far.  I tried putting some on a spoon and covering it with oats; he ate a few of the oats off the very top and then shoved the spoon away. 😆   I also tried spreading some on an Oxbow cookie that he likes, again with some oats on top, but he will not try it.  I would love anything that could help his precious elderbunny self, so I’ll make a few more attempts over the next day or two, but no luck so far.

Thank you again!

 

[Meg]

Thanks so much!  I did end up giving him subq fluids late at night.  He stopped eating again and was loathe to lick the medicine off his plate even with the ear-massage trick, so I also gave him the rest of those by oral syringe.  He was quite feisty at first, which was a good surprise!  Thankfully today he’s a little better, ate all his meds with the ear massage, and is eating oats, pellets and basil again.  I haven’t seen him eat hay in about 10 days, though (can’t rule out him eating some while I was out of the room), so I’m concerned he might have a molar spur — or maybe it’s just the arthritis making him not want to do that much chewing?  We’ll watch him a little more and then make a call about whether to schedule a vet appt.

[DanaNM]

Yeah that’s really tough. How is his attitude? Does he seem bright and like his normal self, or more withdrawn? You know him best and have a sense of how much you want to intervene. Bun Jovi still had a great appetite for salad and treats, and eats his Emeraid with gusto, it was just the hay that he is less into, so I suspect it is arthritis. I also set a personal rule that if he completely stops eating I will not syringe feed him at this point (this was after discussion with his vet).

I do think you should ask your vet about stronger pain meds. Metacam is essentially like ibuprofen, whereas tramadol is much more powerful. I noticed a big improvement in Bun Jovi’s activity and attitude with tramadol once he adjusted to it (he was a bit sleepy the first couple days).

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[Meg]

Thank you so much, Dana!  Yes, I will definitely ask the vet about tramadol next time we go.  That’s a good point.

And thanks for sharing about Bun Jovi — that’s really helpful.  (I think of him as Teddy’s forum brother. 😉  Thankfully Teddy is doing a lot better again, and it’s the same as you describe: enthusiastic for salad, treats, and pellets, just not hay.  His attitude seems mostly back to normal as well.

You’re so right about listening to the bunny on this.  I don’t have a rule set in advance, but would also try to go by how he’s feeling, and I think for me I’d give things at least one (reasonable) shot at helping him feel better and then see how he responds, since his attitude also tends to go with how he’s feeling physically.  He did seem kind of miserable the other night, but getting meds & fluids really did perk him up.  But during Athena’s final two days, there was a major difference when I tried to feed her: she barely chewed but also barely fought — she was just helpless and definitely “far away”.  🙁  So then it seemed clear that we couldn’t reverse things for her.

So we’ll wait and see how he does, but if he has another bad patch anytime soon, then it’s not just routine-related and we will take him to the vet.

Thank you so much again!!  I can’t tell you how grateful I am for your advice and company.  <3

[DanaNM]

Very glad he’s perked up! I am always reminded here that our geriatric buns sometimes just have a bad day for whatever reason. I know Teddy has more of a history of stasis issues so it makes sense he could need a bit more support in terms of fluids and feeding. When Bun has a bad day I start tracking them so make sure they aren’t outnumbering the good days.

Teddy and Bun Jovi are definitely brothers, although they don’t know it!

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[Meg]

Haha I love it!  Yeah, they might not know it, but we do.  🙂

Thank you so much, Dana.  Teddy had another brief little dip the other day, just a half hour really, where he didn’t even want treats.  Massage seems to help, and he’s been a lot better since, but we did make a vet appt for tomorrow evening just to see what’s going on since this has happened a few times in the last couple weeks, and he’s no longer eating hay.  So we’ll ask if his teeth are causing him trouble and/or if he needs to add Tramadol.  I’ll let you know what they say!

Thank you so much!  🙂

[Meg]

Hello again!  So the vet did think his teeth were causing him a bit of discomfort, but she said that at this stage she would hesitate to recommend putting him through a molar trim (though it was up to us).  She didn’t think he’d gain much in terms of quality of life, vs. the ordeal of the procedure and anesthesia.  So we are leaning against that, but what do you think?

She did think adding tramadol was a good idea, so we took that home and are going to start him on it tomorrow morning (since he’s often not himself for a bit after a vet visit, we just wanted to wait a little to let him return to normal so that we can distinguish what effect the new medicine is having). I hope it helps Teddy like it did Bun Jovi!

He also did get one 13-minute session of laser therapy from them, and we’ll do that again next week when he has to go back for a re-check due to the new Tramadol prescription.  Because Teddy gets so stressed out from car trips, we thought that unfortunately a regular regimen of therapy 1x-2x a week would do more harm than good in his case.  (Same for acupuncture, which she raised but they don’t offer it there.)  But I’m hoping at least 2 sessions will do him some good (the vet thought it could).

The vet did bring up that we’re starting to get to the point where the quality of life question becomes salient.  🙁  My partner and I had been thinking about this too, but it was still painful to hear her say it.  She said his heart and lungs sound good, his organs seem to be going strong but his skeletal system is failing him.

But for now, we are just hoping the Tramadol brings him more pain relief.  Teddy is our world, truly, so this is very hard, but we want to follow his lead, and we trust him to let us know what he wants as time goes by.  So far, he’s still very affectionate with us and enthusiastic for food, and does happy tooth-purring, most days.  We’re grateful for that, and we just want to do all we can to keep him as comfortable and happy as possible.

Thank you so much again!

[DanaNM]

This is all so familiar. 🙁  I reached basically the same conclusion about laser and acupuncture. Maybe they would have been helpful to start a year ago, but at this point I don’t think it would be worth the stress because Bun hates the car and being handled, so whatever marginal benefit he might get would probably not be worth it. As far as his teeth, it’s really hard to know. If it gets to the point where he really seems that his mouth is painful to the point where it’s affecting his QoL a lot, then it may be worth trying… but with the understanding that he may not wake up. But he’s on so much pain medication that hopefully it’s not bothering him too much?

I do hope the tramadol helps! He might need a couple days to adjust, don’t be surprised if he’s extra sleepy for a couple days. Also you might need to adjust the dose if he gets too sleepy. We started bun off with once a day with room to increase.

And yeah, I think paying attention to affection and attitude are really all you can do!

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[Meg]

Thank you so much, Dana!  Yeah, it sounds like we are in very similar boats here.  Big hugs to you and Bun Jovi!!

One question about the tramadol: have you found any tricks to get Bun to eat it willingly?  We got a liquid form that I think is compounded (it’s pink and milky-looking) but it’s super bitter (I tasted a tiny drop – yuck!) and Teddy won’t lick it off a plate the way he will his other meds — even with a bunch of simethicone.  We might try injecting it into a little piece of banana?  What do you do?

Teddy was prescribed 10mg/kg twice a day, which is a lot, so we started slow with about 6 mg/kg this morning for his first dose.  I’m not sure how quickly to increase it.  (I should have asked the vet, but I had forgotten about this question until after we left, and now they’re closed for the rest of the weekend.)  How much does Bun get now?

Thank you so much again!!

[DanaNM]

I mashed it into banana at first! His tramadol is the “tutti fruiti” flavor but I think it is still a bit bitter. Now I just mix it in his Emeraid without the banana. I noticed he didn’t like it at first… but now he gets excited about it, probably because he’s somewhat addicted to it?

So are you sure about the mg/kg you were prescribed? What was the actual amount in mL that you give him, his weight,  and concentration of the med?  I just calculated Bun Jovi’s and he started out at 0.18 mL of a 20 mg/mL solution (given once or twice a day). He weighs 3.9 lbs so that works out to be only 2 mg/kg. We were given permission to increase it to 0.26 mL, which would be 2.9 mg/kg.

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[Meg]

Oh good to know!  I tried sandwiching the drops between thin banana slices and it kind of worked once — then mashing into banana was a no for him.  We’ll keep trying!  (Doing oral syringe in the meantime.)  I hope he comes to see it as a help, like Bun Jovi does.

I’m pretty sure — our mixture is 50 mg/ml (maybe why it’s sooo bitter!) and he was prescribed 0.2 ml (1/5 of a ml) twice a day.  So that’s 10mg per administration and Teddy is 1kg (he’s all fluff, especially these days).  According to medirabbit, the typical range is 5-10 mg/kg, up to 15 if needed, every 8-12 hours.  But that’s good to know that Bun had some side effects issues with a much smaller dosage!  We’ve been hesitant to start Teddy out with the full dose — we’re only up to 75% of the strength he was prescribed now (after the 3rd administration).

Thank you so much again, Dana!

[DanaNM]

How has Teddy been doing with the tramadol? I’m going to ask my vet about the dose concentrations, I’m very curious! I know she wanted to start us off low so we had room to increase as needed, so that could explain it.

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[Meg]

Aw thanks for checking in, Dana!  So far so good!  We’re up to the 10 mg/kg twice daily and he seems to be doing well — eating very well again and no more weird tooth sounds.  🙂  We’re so grateful — thanks for suggesting that!

He’s still too smart for our various tricks to get him to eat it willingly, but we are able to draw it up with a tiny bit of baby food and then get the small oral syringe into the side of his mouth so that he eats it that way during “spa times” (his twice-daily hygiene/PT sessions).

That is interesting about the concentrations!  I know your old vet liked to dose on the low end — maybe this one is similar?  I’d be curious to hear what she says!

Thanks again, and hugs to you and Bun Jovi 🙂

[DanaNM]

That’s great he’s doing well! I asked my vet about it (who has been very good so far and gave the expected higher amount of metacam) and this is what she replied:

“Tramadol usage in rabbits is still very anecdotal with no formal research on dosing. The Veterinary Information Network formulary does list 10 mg/kg every 12-24 hours for dosage.
When I consulted with a veterinary pharmacist when when we first started prescribing they stated that that dosage is MUCH higher than they recommend which is why I dropped down to 2 mg/kg. Some veterinarians even start lower and just titrate up to a sweet spot that helps control pain but does not sedate them.”

So I think the situation is basically that you can start low and just increase till you see a benefit, or if you start higher and are seeing too much sedative effect, drop it down!

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[Meg]

OK cool, good to know!  Thanks so much for sharing this.  (We haven’t noticed any sedative or other side effects for Teddy, thankfully.)

How is Bun doing?

[DanaNM]

He’s doing OK…? the newest issue is he had a bulging eye. I was concerned about eye pressure so I took him into the vet. Turns out his eye pressure was low due to inflammation of the eye tissue itself. So he was prescribed an eye drop and she wants to re-check in a month. It didn’t seem to be bothering him so that was good?  Other than that relatively stable, but with some slightly fluctuations in appetite and attitude. Nothing too dramatic though lately.

That’s great Teddy is doing well with the tramadol, I’m glad it seems to be helping him!

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[Meg]

Aw Bun — I’m glad he’s hanging in there.  I’m sorry to hear about the eye issue but am glad you got him help and he doesn’t seem bothered.  Teddy’s had more eye infections over the past few months (but thankfully they’ve always resolved with antibiotic eye drops so far).  I hope Bun Jovi’s eye gets better soon!

Thanks so much again for all your help with Teddy.  🙂

[Meg]

So, I’m hoping we’re still a good ways away from this, but I wanted to ask everyone for input on how you can tell if your elderbun is just too uncomfortable. 🙁  I’ve never had to make this kind of call before, and I’m pretty terrified of it.

Teddy did really well for a couple of weeks once we started tramadol, and now he’s got a little more variation day to day.  Earlier today he didn’t want any food except for his very favorite treat, and he hadn’t been pooping, peeing, or drinking much, so I gave him some fluids and he’s been eating, pooping, and acting better.  Right now he seems pretty good, but my partner and I had a teary conversation earlier about how we may have to face this question depending on how he does.  From what our vet says, he might end up in the position where his organs are still going strong but the discomfort of his arthritis & spondylosis just gets too bad for him.  🙁

For background, Teddy lost the ability to hop this past May, and the ability to limp around in June.  He’s not paralyzed, but his legs are kind of twisted so he can only groom his face with one of his paws, and he spends his days lying in these two cat beds we got (that he alternates between every 12 hours or so to give him a little postural variety).  He can keep his head and shoulders upright, but he can’t sit or stand without a lot of support.  He can’t reach his back feet to groom them unless we hold them closer to his face for him.  We give him “spa times” 2-3 times a day for hygiene, massage, some PT, etc., and he has a lot of stuffed (plush) animal friends to cuddle and groom.

I’ve heard about watching his level of appetite, affection, and attention.  Are there other things we should look for?  Right now he seems to be perking up (we just had family cuddle times and looked at photos/videos from when he first came home from the shelter in 2009), but over the past few days these 3 indicators have been a little less consistently strong.  Again, I’m hoping he just had a little rough patch and that he has more good time left, but I’d love to know anything more we should look for.  We love him SOOOOOO much!  I’ve never had to even consider euthanasia for a pet before, and I’m so so scared of making the wrong decision.  (Not to judge anyone else’s choices, but just for myself, it feels so overwhelmingly profound: how do I decide for another being that they would rather not be alive??  But then, we don’t want to fail him by making him suffer too much either.)

Thank you so much.  Man, I would give anything to keep him happy, healthy, and comfortable forever!!!

[Bam]

Honestly, I think you’ll know. You know him as thoroughly as anyone can ever know another individual.

Vets here say people as a rule choose PTS too late. I think I did with my dog Effi. Because I did “wait and see” for 5 days after I saw the light had gone from her eyes and her life was just pain, which she stoically accepted. She had “snapped back” so many times. (She wasnt even 11 but she had a bad back.)

I dont know if one should wait until life becomes unbearable. With humans we wait a lot longer than that.

It’s good you’re having the discussion. With my Vilde (Teddy’s little doppelganger), I decided when he first fell really ill that I would not put him through anymore invasive treatments. Once the acute GI stasis was dealt with and he started gaining weight again (which took 5 weeks of rather intense treatment), we carried on with simple meds (meloxicam and ranitidine which was still available back then) and daily supplementing with CC. For 1.5 years he was active, affectionate, quick as a weasel and really interested in his surroundings. He loved his daily porridge oats and grated carrot. Vilde was a lot younger than Teddy though, only 8.5 years when he took that final turn for the worse and I made the decision.

The spark in the eye, when that dulls, I think it’s time. But it will never be easy.

 

 

[DanaNM]

This is a really hard decision, I pretty much struggle with this daily with Bun Jovi. I basically track good days and bad. I’ve used this survey and I found it to be really helpful: https://vet.osu.edu/vmc/sites/default/files/import/assets/pdf/hospital/companionAnimals/HonoringtheBond/HowDoIKnowWhen.pdf

Things like being interested in surroundings, interested in favorite toys, and being happy to see you are all important. I don’t want to wait until Bun Jovi is just miserable because I didn’t notice the signs. I’m on the same page as Bam, where we have decided we won’t do any invasive treatments for him, just palliative care.

One thing you might try is to scale back his tramadol a little. Recall that it can cause them to get sleepy and have reduced appetite. I went through a phase with bun where I thought he was just going to stop eating, but we reduced his tramadol a bit and he had a much better appetite.

I think it would be good to discuss these things with your vet as well. My vet was really helpful when we talked to her about what indicators to look for.

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[Meg]

Thank you both so much — I really appreciate you sharing all this.

[jerseygirl]

Bun Jovi and Teddy are blessed to have their humans who care so deeply for them. Vilde was another blessed with such an attentive, loving person.

I haven’t commented much here but I have been routinely checking in on these old boys.
xx

“Honestly, I think you’ll know. You know him as thoroughly as anyone can ever know another individual.”

I agree. I know that solely relies on intuition and therefore, trust in yourselves, but it’s so often what people report after they’ve had to make that call for a beloved animal. They just knew.

You might even feel one day he’s already started to leave and in a strange way, that makes it “easier” (for want of a better word) on us as we feel the inevitable is happening so we are merely aiding that to be a peaceful transition.

[Meg]

Thank you so much, Kate!!  You are so kind to write, and it makes me really happy to hear your perspective.  I really appreciate it.

[Meg]

Hi everyone!  Teddy has some new issues that I’m not sure what to do about, and I’d love your advice.

After I wrote, we did try decreasing Teddy’s tramadol by 20% and he perked up for a while after that!  For a couple of weeks he was eating everything quite well (except for hay, which he hasn’t really eaten in a couple months) and he stopped needing fluids.

But then starting a couple of days ago, some new issues:

1. He’s started getting iffier about eating pellets and greens (he’ll eat some, but less reliably) and seemed to basically only reliably want his Fluffy Bun carrot cookie (which we give in tiny pieces since it’s just oat flour and carrot — not much fiber).  It’s been harder getting him to eat anything with hay/fiber in it, like pellets or Oxbow supplements, although he will sometimes eat them.  Unfortunately, he’s always been a hard no on anything in the Critical Care family, even EmerAid, no matter what we put in it to tempt him.  We would have to force-feed it to him, which he hates, so we’re reluctant to put him through that at this stage unless it’s just super temporary.  He did end up finishing his greens last night (cilantro and a bit of kale), but slowly; he only ate half his greens the previous night, and he doesn’t seem to want his fresh basil in the mornings anymore.
2. He’s stopped finishing the medicine he usually licks off a plate (this is meloxicam and cisapride, each with simethicone mixed in, and some famotidine in the meloxicam too).  He usually will go for it initially, but then keep turning his head away, and we have to trick him into finishing it by massaging his ears till he starts licking.  It almost seems like it’s more that he’s uncomfortable and needs to keep moving his head than that he doesn’t want the medicine per se, but we’re not sure.
3. He’s been peeing a lot, almost colorless pee, in the past day or so.  We did give him about 75ml of subcutaneous fluids (Lactated Ringer’s) yesterday and 50ml the day before.  This is all the subq fluids he’s had in the past week or two.  He has not wanted to drink water from his bowl for the past couple of days, though he drank more last week.
4. He kind of licks his chops periodically (I don’t think this is quite the right expression, but I don’t know how else to describe it), especially if he’s just eaten something dry.  He’s actually been doing this on and off for maybe a week or two.  What I mean is: after he’s done eating, or sometimes just out of the blue, he’ll kind of move his mouth around in a chewing-like motion and stick his tongue out to lick his lips or whatever, kind of like you do when your mouth is dry or you’ve just eating something too tart, etc.  (If you imagine opening and closing your mouth while pushing your tongue outwards repeatedly, you might be able to picture it.)  I don’t know what this means, but it looks uncomfortable.  He never wants to drink from his bowl when I offer it, though.  Not knowing what else to do, I’ve actually started squirting water onto his mouth area with a little spray bottle when this happens.  Then he starts licking the water off his fur, I spray a few more times while he’s licking, and then once he’s done licking up the water he settles down for a while and the chops-licking movement thing doesn’t come up again for at least a few hours.  (Last month, the vet had said he did have one molar longer than the others, but that it was not clearly a major issue and she’d hesitate to recommend putting him through a molar trim at this stage.)  I was hoping that the subq fluids might help, but it’s not clear that they do.

Despite all of this, he’s actually seemed to be in pretty normal spirits/alertness.  He doesn’t seem uncomfortable most of the time.  He enjoys pets and massage, and does normal tooth-purring with me some of the times I do this.  Sometimes he naps, and other times he just kind of sits up and looks at me expectantly, like he wants something, though I haven’t had any success yet at figuring out what he’d like (other than pets).  I’ll try offering EmerAid one more time, though I’m unfortunately not optimistic about that.

What do you think?  I have no idea about the chops-licking thing or how to interpret this situation.  I’d love to know how to help him.

Thank you so much!!

[BZOO]

Sorry your boy is having a rough time.

When it comes to “that decision”, listen to your heart…you will know.

I had a dog that was nearing the end.  I told him, just make it to your 15th birthday.  He did, a few days later he gave me the look and I knew he was ready to go.

Afterward, you will ask yourself was it too early, did I wait too long?

This is normal.  Rest assured you will do what is right for Teddy.

[Meg]

Thank you so much, BZOO!  I really appreciate it.

I’d love your and/or anyone else’s thoughts on what to make of the 4 new symptoms I listed above.  I’ll just add that today we did not give subq fluids and his urine has color again.  I tried decreasing tramadol further (to 50% of the original dosage) so we’ll see how that goes.  Teddy was very reluctant to finish his medicine (even with the ear massage trick), but he does a lot of grooming as well as licking my hand, so I don’t think it’s a movement issue.  He’s eaten maybe 1/3 of his greens so far.

Tonight I noticed his top lips were moving apart more than I recalled being typical when he’s just sitting their breathing, so after some Googling I wonder if he has some respiratory irritation.  His room is *far* from clean and there was too much wet bedding piled up next to his bed (normally I put it in a trash bag before it goes into the laundry, to cut down on the smell), so that could be it.  I cleaned up a bit and will do more (plus vacuuming) tomorrow, and hope that will help.  Poor bun!

He’s still very cuddly, though.  He loves being petted, and shoves his head further under my hand than usual.

[Bam]

I think its important that you keep giving the sub q fluids. If he eats little fiber he won’t feel thirsty, but his body still needs fluids.

Rabbits are obligate nose breathers, so  if a bun is breathing through its mouth, sth is wrong, especially if the bun points his nose up.

The licking sounds like some type of local discomfort, but it could probably in response to any kind of discomfort since he doesnt have a big repertoire of movement nowadays.

 

[DanaNM]

Hmmm, this is tricky. The excess colorless pee could indicate kidney failure. Excess urination without excess drinking is worrisome. The licking of the mouth and mouth movements could indicate some dental pain, especially since the vet did notice some molar points. The reduced appetite could be from the dental pain, or it could be from kidney failure as well (or a number of other things).

I would share this info with your vet and see what they think. They may want to reduce his metacam and increase tramadol to compensate. Have you tried offering critical care cookies?

It’s challenging because in a younger rabbit, there are measures that could be taken for these things, but in a rabbit as old as Teddy (or Bun Jovi), it could all be a sign of things starting to shut down, or a piling up of things that will be difficult to treat (such as a complex dental issue).

 

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[LBJ10]

Isn’t “dry mouth” a side effect of Tramadol in people? Maybe Teddy just has dry mouth. It can take awhile for side effects to show up sometimes. Plus if he’s not eating as much, he isn’t going to be producing as much saliva anyway.

[Meg]

Thank you so much, everyone!  I really, really appreciate your taking the time to write.

I had the same thought about the tramadol and dry mouth, which is why he’s down to 50% his prescription (so 5mg/kg now, and probably a bit less since I don’t get it all in his mouth) as of the past 24 hours.  If it helps, great; if he seems more painful, we’ll increase it.

I did give him fluids again today — thank you for that.  I’m sure that whatever is going on, it can only help.

I’m pretty worried about his breathing now though — it hasn’t gotten worse, but it hasn’t gotten better.  His nose is a bit raised — not dramatically, not above his eyes, but more than usual.  With his raised nose, I can see his throat going in and out, which is weird.  His breathing rate still seems normal and I don’t see any discharge, and he’s not making a noise when he breathes, but still.  He’s barely eating today. 🙁

So I called the vet and they said to bring him in tomorrow.  They also said we’ll be talking more about quality of life issues, depending on how he looks, so it’s been a teary evening.  My gut says this is just another challenge he needs us to figure out, rather than this being the end — but of course that could be wishful thinking.  He’s our world.

Thank you so much again and I’ll let you know what the vet says.

[DanaNM]

(((HUGS)))

 

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[Meg]

Thank you, Dana! His breathing does seem worse now and I am super worried.  I’m camped out next to him for the night.  He’s raising his nose higher, and moving his head around more too like he’s uncomfortable.  Then every so often he starts to struggle like he’s trying to change position, making unhappy noises, and I help him try to sit up — after that, he’s worse off for a couple minutes, opening his mouth much more (with his lower jaw) and making a clicking sound when he breathes.  Then once he’s settled down, he’s back to no sound, and closed jaws, but top lip spreading when he breathes.  He still moves his head around pretty often.  I have him propped up as upright as I can manage, but he’s still moving his head around quite a bit.

I’m so worried for him and I *haaaaate* not being able to help him!!!

[Bam]

(((HUGS))) from me too.

 

[Meg]

I’m sorry to say, Teddy passed away a few hours ago, while I was holding him.  Just after I last wrote, it was time for Teddy’s medicine and spa times, and as I didn’t know what was going to happen, I wanted him to have his pain meds and all.  He actually took them pretty well and then we had a surprisingly peaceful snuggle time with him on my lap and me grooming his face with wipes and a brush like usual.  He seemed relaxed, and didn’t seem to be struggling to breathe as much.  I sang him the song I used to sing to him when he was sick a few years ago (just substituting some of the words of “Dear Theodosia”).  Then I started more grooming and he started to struggle again, like wanting to change position.  I thought maybe the grooming bothered him so I put him back in his bed, but he was still struggling pretty frantically.  So then I tried putting him back on my lap, but he wouldn’t settle.  He started to not only do the clicking sound, but also to jerk his head to the side pretty hard every like 5 seconds or so, and then he started kicking extra hard.  I didn’t know what was going on, and tried in vain to help him get more comfortable, and then like 5 or 10 seconds later, I felt him kind of go limp in my hands.  I put him in his bed so that I could look at his face, and he was still.  He had passed.  I yelled for my partner, who was asleep in the other room, and he came and we sat next to him for about an hour and a half before my partner went back to bed.  I’m still here now, and my head hurts from all the crying (which I know will keep on for quite a while).

I can’t put into words all the things I feel, but it is a mix of both *really* acute grief and also gratitude and awe for getting to be in the life of such an incredible bun (and amazing pair of bunnies).  How in the world did he manage to spend like 10 or 15 minutes of peaceful snuggle time with me in the middle of his respiratory distress, and up until only a couple of minutes before he passed?  That blows my mind.  He is magical.

I’m also grateful of course that he’s not suffering anymore, especially with the struggling to breathe.  I love him so much.  I’ve been phenomenally lucky to get to spend the last 13 and a half years with him, and/but I cannot imagine how I will do life without him here.

Thank you so much for all of your generous advice, encouragement, and company all these years.  I know it saved Teddy’s life many times!!  I’m really grateful for everything.

[Bam]

Meg, I’m so sorry 💔

It seems he went peacefully. Rabbits tend to seize in the agonal phase, not rarely do they also cry out. It is believed they’re nolonger aware at that stage.

Teddy was the luckiest of rabbits. He was magical, and so are you!

I feel it’s helped me with my bridge pets to know I’ve done everything I possibly could. You really did absolutely everything. It doesnt take away the grief, but at least it means less feelings of guilt, which we always tend to feel when a pet passes.

It was good that he got to go at home, with you next to him, after a good long cuddle.

Binky free, Teddy ❤❤❤

[BZOO]

Hugs to you and yours.

That last spa treatment and cuddles was his last gift to you.  Remember that when times get tough.

What a lucky bum he was to have you.

[DanaNM]

I’m so sorry Meg 🙁

Saying he was a lucky bun to have you is a huge understatement, and you really did everything you could to help him have a peaceful and comfortable passing.

(((Binky free sweet Teddy)))

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[Meg]

Thank you so much, everyone.  I really, really appreciate your kind words.  And it’s helpful to know about the seizing — thank you, Bam.

Today has been a mix of bouts of sobbing wildly interspersed with moments of feeling calm and gratitude.  It’s weird having such a strong combination of feeling lucky and feeling heartbroken all at once.

Thank you all so much, truly.

[LBJ10]

I’m sorry Meg. One thing I remember was the vet saying I did a good job. That meant a lot. I think we can all agree that you did a good job. Teddy was so lucky to have you.

[Meg]

Thanks so much, LBJ.  That is really kind of you.  I definitely feel like the lucky one.

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