Rhinostomy Experiences

[Em]

I have my girl scheduled for a rhinostomy hopefully this week. History of chronic snuffles for the past few months that will not respond to treatment so this is our last resort as all other treatment as failed. She is 7.5 years old and while I know she is older to undergo such a procedure, she is so incredibly fit and active otherwise and her blood work has come back all good. I’ve been braced that there is a lot of surgical aftercare as she will have a literal hole in the middle of her face. While I’m prepared for that and will do literally anything she needs, is there anyone that has had this procedure done on their bun that could provide any helpful tips/things you think I should know/have? If you could also let me know how fast your bun recovered. I know they are all different, but it’d be super helpful to hear of anyone else’s experiences. She is also having a problematic molar trimmed at the same time that was discovered on the CT (it’s growing curved apparently – she does get annual vet checks that are now changing to every 6 months, so not sure how this has gone unnoticed at those check ups). Her bad diet earlier in her life accompanied with her breed has made the dental disease diagnosis unsurprisingly honestly, but still was like an extra blow on top of everything else.

I’m literally sick with nerves over the thought of this surgery and praying it goes as smoothly as possible for her. We lost her brother 2 months ago (he had a host of issues, but ultimately we were awaiting a possible rhinostomy but his snuffles caused pneumonia and ultimately his heart just gave out), we lost him exactly 1 year & 1 day since losing our other sweet bun to a tooth root abscess. She has been alone since, so there is no risk of another rabbit grooming her surgical site. While I spend as much time as possible with her, I know I can’t take the place of another rabbit. So hopefully once she is fully recovered, she will be paired up again in the near future. I’m just really really hoping that this surgery helps. I’ve been told by some people that I shouldn’t bother, and that it’s not fair due to her age… but to me she is still full of life, and one of my other rabbits lived to 13, so I have to give her this chance.

[Wick & Fable]

Here’s a recently documented experience w/ it (not mine personally, but I know the user who provided the link to share their experience; overall positive): http://rabbitors.info/juliet-nasal-infection-2023

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.

[Em]

Thank you so much for that link, irs been super helpful!

she had her surgery Wednesday & came home yesterday. They removed massive rhinoliths from both sides of her nose. The wound is no where near as gruesome as I was expecting, so I hope it is a quick & easy recovery & that this hopefully cures her chronic snuffles going forward!

[Em]

Well, I’m going to continue to update this thread so I have a timeframe for my own sake and maybe our experiences can help others in the same situation:

she has now had 2 x rhinostomy surgeries. The 1st she had in September, followed by a nasal flush in October (where saline was injected into the site she had bone removed from previously) and the 2nd procedure she had in December were they discovered she had recurrence of rhinoliths in both side of her nose and reopened the nose like the 1st time. They were removed, and she recovered well after surgery, but the sneezing while has reduced has persisted 🙁

I have lost count of how many CT scans and culture tests she has had at this point since our journey began. But her most recent culture tests have all yielded no significant findings of any bacteria present in her nose, so it is now believed her sneezing is chronic and due to the damage done to her nasal cavity from the rhinoliths and that this is now a lifelong condition. Good news, is that her sneezing is no where near as bad as it was and her breathing is very good and basically normal (aside from occasionally hearing a slight “honk” on the rare occasion she’s inhaling a treat).

we are now trying a new medication (pulmicort) in the hopes that this reduces the irritation in her nose and further reduces sneezing. I haven’t seen any mention of others using this medication on the forum so it’s hard to determine the success rate of this in rabbits and how quickly it takes to see improvement if one is to be seen. We just finished day 1 of a 2 week prescription, so we have a while to go, but already I feel I can hear an improvement and her sneezing seems to have already reduced. Maybe I am wishful thinking, but I am still holding onto hope that it will stop it altogether, even though I know the chance of this is slim. I would pay all the money in the world to just see her with a dry nose and to be able to be paired up with another bun again 🙁

 

 

[Bam]

Thank you for the update!

I’m sorry she’s still having some trouble. I had a bun tht had chronic nssal “stuffiness”, probably related to the shape of his face (he had a very flat face). It didnt improve at all with antibiotics, but it didnt seem to affect him much. He had lots of binkying energy.

The pulmicort (budesonide) is interesting. How do you apply it? Budesonide is a corticosteroid typically used for asthma or microscopic colitis in humans. I use it for asthma if I get a chest cold.

 

[Em]

She’s also a flat faced bun (lionhead) so I think that’s also a contributing factor to why she got it so bad in the first place unfortunately 🙁

this morning I didn’t hear her sneeze once, and when giving her her morning snack she also didn’t make a sound! When I ALWAYS hear her make that honking sound since her problems started. So it’s super promising so far though trying to not get my hopes up. She’s still her spunky self regardless but I would just really love to be able to pair her up with another bun again as she just loves other rabbits so much and has been alone since losing her brother to complications from chronic snuffles last July. I don’t believe she’s contagious as her bacteria swabs are negative but I’m so afraid to risk it.

In terms of administering it, she gets in her nebuliser twice a day. She gets 1ml of the pulmicort in 4ml of a 3% saline solution. It typically takes about 20mins or so per session.

[Bam]

Seems like the pulmicort is helping! I asked about the administration bc I use it in an inhaler and that could obviously not work for a bun 😄. (It comes as pills too, for microscopic colitis). Nebulizer sounds like a great option!

It does sound like the risk of her transmitting anything to another bun would be very low. I hope she can get a new bun friend soon! It does so much for their quality of life.

[Em]

Well, I spoke too soon, I’ve heard her sneeze a couple times now and back to occasionally honking when she’s eating or sniffing for something. On the bright side though, it’s definitely helping as it’s significantly reduced compared to before, so I’ll consider it a win nonetheless! As her sneezing is due to damage in her nose, I knew the likely of it curing it altogether was basically slim to none. But, if this makes her more comfortable, that’s all that ultimately what matters to me. Plus we still have a while to go on this medication so she could still further improve with it yet.

& yes, I totally agree that having a companion totally improves their quality of life, no doubts about it! She has never been alone, ever, in her whole life since losing her brother in July. She was originally part of a quartet but I lost my other three at just 3 years old, 5 years old and 6 years old to breed related issues 🙁 it’s been terrible, and why I’m so terrified of pairing her up in the off chance she gives this to another bun – I don’t think my heart could handle it.

If she got the all clear that she definitely wasn’t contagious I would have her paired up in the morning. I’m definitely going to discuss it with my vet at her next appointment for sure. I don’t agree with single buns at all – but in our case, it’s been medically necessary unfortunately 🙁

[Em]

Welp, I fear we are back to square one 🙁

Sneezing & discharge is back in full force. Back to the vets again.

I’m only reading now that there’s a risk of pulmicort reducing your immense system and making you more susceptible to infections and I really hope that’s not what has happened here. Has anyone else ever dealt with such chronic snuffles? We have been treating for almost an entire year 🙁

[Em]

Another update:

Just collected her from the vets after her 3rd rhinostomy. she had a repeat CT scan on Thursday which showed rhinoliths have reoccurred in her nose again, so they’ve opened her nose back up and removed them. I asked for a repeat culture just to be on the safe side, so so far no antibiotics until we hear back from that within the next week or so. At the moment we are flushing the site 3x daily, applying SSD cream around the wound & she’s on metacam and calpol both to be taken 2x a day.

My poor sweet girl. She’s been an absolute trooper. I feel absolutely terrible for putting her through so much, but I just believe she has so much more life to live that I have to give her a shot. She’s already back to eating by herself and is hopping around exploring her new temporary medical pen. I’m really hoping this cures her, even though it’s unlikely. At the very least I hope we get a very very long time before further reoccurrence.

I wish I found a way to stop the rhinoliths from reoccurring 🙁 I need to revisit her fresh food list again and just eliminate anything high in calcium, but it’s so tough because most veggies and herbs are.

[LBJ10]

This is such a rare thing, it’s difficult to to find any literature on it. One thing that I did find is they can be associated with an ectopic tooth invading the sinus cavity. This makes you wonder if tooth roots invading the sinus cavity could cause also this. One of my bunnies had chronic problems with his sinuses due to overgrowth tooth roots. No rhinoliths that I’m aware of though.

You said you had a CT scan done. I wonder if the vet can see that in the images. I’m just thinking of reasons why the rhinoliths might grow back. Usually if they are removed completely, they don’t recur.

[Em]

She’s had about 5 CT scans and they are as just at a loss as to why they keep coming back as we are.

her recent CT showed 7-8 stones and 7 were removed. They did a much larger site this time to make flushing easier, so I’m hoping that will go in her favour. But yeah they can’t give me a reason for why this keeps happening either. Apparently while it’s a rare condition it can be common in rabbits due to the amount of calcium they produce and excrete? I’m just parroting what is written on her discharge report

we have checked her teeth every time too, but her vet is confident that is has nothing to do with her teeth (she has had two dentals though, but apparently it is definitively unrelated).

[LBJ10]

Honestly, you are the only member who has posted about such an experience. At least the only one I’m aware of, I did not do a forum search. Googling yields very few results. Most animal cases seem to be cats or dogs. When it comes to people though, I know that removing a rhinolith tends to solve the issue and they don’t often grow back. So yes, this is puzzling.

[Em]

I couldn’t find much if really anything at all on the condition either. I too also read that once they are removed they typically don’t come back, so the fact this is our 3rd reoccurrence so so disheartening. She’s recovering a lot more slowly this time around too. I think with her age, if they do recur, I think the ethics with putting her through another surgery would be questionable. So I really, really hope that this surgery is successful and that she starts to recover a lot more smoothly soon 🙁 I hate seeing her so miserable. She is still alert and grooming herself but she seems to definitely be feeling it now and I’m assist feeding her. She will take some nibbles by herself here but not as much as she was happy to eat when she first came home.

can I ask if her pain medication seems right? She’s a 2.3kg lionhead. She’s on 1.3ml of calpol 2x daily and a 34kg dog dose 2x daily. I’ve never had a rabbit on calpol before and her metacam dose seems very high. Is this okay?

[Em]

I’m pretty stressed now. She won’t eat by herself at all. She’s flopped to lie down quite a few times now and her ears feel a bit cold.

I’m feeding her more critical care while I wait a lift to the vets. I feel literally sick with worry 🙁

[Bam]

I’m sorry to hear this, great that you’re taking her in!

I’d not keep feeding her if she has eaten within the last 6 hours. If there is an obstruction (so nothing can get out of the stomach), feeding is bad. Even giving water is bad if there’s an obstruction.

Calpol is ibuprofen. I’ve never given ibuprofen to a rabbit. Medirabbit says 3-10 mg per kilo body weight 1-3 times per day for a rabbit;

For metacam, Medirabbit says 0.3 -0.6 mg up to -1.5 mg/kilo body weight per day, once or twice per day I had a bun that was on 1.2 mg/kilo metacam twice daily for many months, so for buns with some diagnosis (arthritis, chronic dental problems) a high dose can be quite ok.

http://www.medirabbit.com/Safe_medication/Analgesics/safe_analgesics.htm

[Em]

I only force fed her as I was pretty sure it wasn’t an obstruction based on the fact her surgery was so recent so I assumed it was due to her pain management not being strong enough.

I also checked the camera I have on her and she didn’t eat during the night from what I can see. I just dropped her up to the vets there. Of course it would be a bank holiday when this happens too. She’s gonna bankrupt me, but all I want is for her to be okay.

they’re gonna start her on IV pain relief and fluids and maybe also antibiotics (she’s been on none while they await culture results). So hopefully they call with good news later. I did think she was discharged pretty quickly. The first time they kept her for like 3 days after surgery, this time it was a bigger surgery and they discharged her same evening. So I think it’s the case that her pain isn’t being managed properly and she doesn’t want to eat because she’s just so uncomfortable

[Bam]

Yes, I’m sorry, I didnt realise that she was so freshly out of surgery! You were right to feed her.

I hope she’ll perk up considerably with IV fluids and pain meds, possibly also abx. There’s only so much we can do at home. It does get very expensive though, according to my insurance company, vet fees has increased by 25% during 2023 due to inflation, which is crazy.

[Em]

That’s okay, it’s a relief to here I was right in force feeding her – I was worried a bit there that I’d somehow made it worse

& yeah, the prices are absolutely crazy. In Ireland there are also no insurance companies that will cover rabbits, so everything is pay out of pocket. Since September, she has cost over €3k in vet bills. Her most recent surgery she had there was €1.4k. For her trip today I was quoted €150-€400. But, I’m a firm believer when you have animals you look after them. I set her up her own savings account with my bank and contribute to it with each pay check or I don’t know how I’d afford it otherwise! I wish there were insurance companies for rabbits here, because I do believe there’s a market for it.

but yeah, please God she does okay. The poor girl has been through the wars. Today is her birthday too 🙁

[LBJ10]

I apologize for not responding. It was in the middle of the night for me. Bam gave you some good advice. Medirabbit is always a good resource for finding dosage recommendations for different meds. I do hope that the IV and pain meds will perk her up. I agree that she should have probably stayed at the vet longer instead of coming home.

[Bam]

I was completely wrong about Calpol. I am sorry. I had never heard of it so I googled it and got it completely wrong.

Calpol is paracetamol. There are different strenghts it seems? It makes a lot more sense to give paracetamol instead of ibuprofen in combination with Metacam. It is a rabbit safe drug.

The metacam dose you gave was 1.5 mg/kilo bodyweight calculated like this:

Standard dosage for dogs is 0.1 mg meloxicam per kilo body weight. A 34 kilo dog-dose thus means 3.4 mg meloxicam. 3.4 divided by your buns weight 2.3 kilos = 1.48 mg/kilo body weight.

I’m very grateful I have insurance, but insurance is also a driver of vet costs. Vet care is very expensive here and it seems even worse in the UK. Last summer a friend had to take her dog to France for MRIs because she didnt have British insurance for her dog. She was quoted 12000 British pounds for MRI in London. In France the cost was 600 euros without insurance. Same level of care.

 

[Em]

Sounds like her dose is about right then? I think it’s just not doing it for her. They have her on a IV of pain relief at the vets now and she seems to be feeling a little better. Good news is that her gut is moving again and she is pooping so thank God for that. She is still not eating by herself yet but at least we are a little step in the right direction. She’s definitely going to be staying with them overnight by the looks of it (and to be honest, even if she did start eating by herself again, I would still ask them to keep her for the night to be on the safe side).

And yeah I’ve seen the prices in the UK even with insurance and they seem mental. Even the cost for pet insurance in the UK seems a bit high. I have pet insurance for my dog and I pay about €220 per year – that’s for vet bills up to 5k (with a few other benefits) and €100 excess. I’ve seen some people pay that monthly for pet insurance in the UK, which is crazy. The prices for vets here are still a bit high, but definitely not as high as they seem for the UK or even US/Canada – which seem to have crazy prices a lot of the time. the CT scan here cost €400 for my 2.3kg bun, so I am grateful they are not super extortionate! I do wonder how they come up with their prices a lot of the time. I understand it’s a business after all, but profit margins must be crazy

[Bam]

Sounds like the right dose, but meloxicam isn’t a very potent painkiller- it is similar to ibuprofen for humans. Vets can give stronger stuff, opioids like buprenorphine or fentanyl.

Great that her tummy is moving! I’m glad they’re keeping her, I would’ve wanted that too. It feels a lot safer!

[Em]

They’re keeping her again today as she is still not willing to eat by herself.

She is still being force fed and they’ve been doing sub-q fluids as they’ve been unable to place a catheter apparently. Her usual vet is in tomorrow and I just really hope she starts to improve and feel better soon. Of course today would be another bank holiday. Don’t even wanna know how much this is gonna cost me, but she is worth every penny.

even though they’ve been able to force feed her I am still so worried about her. They still think she will come around and start eating by herself when they get better control of her pain, but of course my brain is jumping to worst case scenario and fearing she’s gone into sepsis or something. I know it’s a stupid thought but she is my literal baby and I just desperately want them to call me and let me know that she’s eating again by herself and has made a full recovery

[Em]

Just another update in case anyone’s experiencing anything similar:

She is still at the vets. They said she had an ‘episode’ last night where she appeared to have a seizure for about a minute. She had another seizure that lasted 5 minutes again this morning. She is drinking by herself and has started taking nibbles of her veggies herself, but the seizures are obviously super concerning. I experienced seizures with my previous rabbits but they immediately died afterwards. So safe to say I am absolutely up the walls with worry.

Her culture tests have all come back negative for bacteria, but she’s having a blood test and I believe they’re doing a check of her heart too to be on the safe side. I have also asked if we can start treating for assumed E.cuniculi, as her brother she lived with until his passing was positive for EC – so not sure if the stress from surgery and the vets has just made her symptoms raise their head? But better to be safe than sorry, as I have always regretted not pushing for her brother to start his treatment sooner vs waiting for results to come back.

Best case scenario, if there is one, is that they are stress related seizures. Please God this is the case and she starts feeling better soon. She did so well her first two surgeries that I really didn’t think twice about this one. This will definitely be her last one. I couldn’t put her through this again 🙁

[Bam]

I immediately thought EC too, I hope they are willing to consider that and start treatment asap. EC is opportunistic, and flare-ups often occur when/if the bun is stressed by something else. EC is probably the most common cause of seizures in rabbits.

Fingers so very crossed for her. It must be so scary for you.

[Em]

Good news it that her blood test show that her liver & kidneys are good. They said her white blood cells are a bit elevated and agree that EC is a possibility so she is starting her treatment for that today along with antibiotics – just to be on the safe side. Most likely gonna be staying at the vets for a while yet, but honestly as much as I want her home it’s the best place for her at the minute

To say I am absolutely terrified would be the understatement of the year. They say with all things considered she looks good. But of course, I can’t help but worry. Just so desperately want her to be okay

[Bam]

It’s great that they listened to you regarding EC and that they are starting treatment!

Also great that kidneys and liver are fine!

I agree it’s best for her to stay at the vets now. We want them home with us of course, but it’s scary and exhausting to sit and watch over a poorly rabbit.

As you know, EC meds often take a while before they kick in.

 

[LBJ10]

I do not blame you for being scared! Your bunny isn’t well and you feel completely helpless. But you are doing what is best and that is keeping her at the vet until she is doing better. I’m glad they decided to begin EC treatment. The stress can absolutely cause an EC flare.

[Em]

So she’s back to herself again and has had no seizures since, so that’s good news!

But they did discover an abnormality on her cardiac scan. They noted the right side of her heart seems enlarged and suspect a mass on her tricuspid valve 🙁

not great news obviously, but I know she’s 8 years old. She isn’t symptomatic and it was purely an incidental find. Hopefully it remains that way, but I know realistically it will eventually likely rear its head. I don’t dare ask for a prognosis. Hopefully it stays away for a while yet. She is going to be getting a proper assessment of her heart soon to see exactly what it is going on, but not until we’re completely out of the woods from this week from hell

[DanaNM]

I’m glad she’s improving! Not great news about the cardiac abnormality but it’s good it’s asymptomatic.

. . . 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.  

[Em]

Yeah it’s worrisome to hear she has a heart issue for sure, but I am glad that she isn’t symptomatic to hopefully that goes in our favour.

I just collected her from the vets this evening, so I’m super happy to finally have her home. But when I dropped her off with all her medicine, it’s only when I got home that I realised when they gave me back her meloxicom they never put the syringe back in the box with it 🙁

 

does anyone happen to know what a 34kg dog dose (1.5mg/ml) equates to in ml on a syringe?

[LBJ10]

What was she getting before?

I’m glad to hear she is doing better. I’m sure it’s a relief to have her home now.

[Em]

She was getting a 34kg dog dose 2x a day but they forgot to put the syringe (that has the kg measurement) back in the box when they discharged her. I was able to get in contact with her vet though and they were able to tell me what this equates to in ml on a normal syringe so I could give her her medicine as normal.

poor girl is on a concoction of meds. She gets parazole 1x daily, metacam x2 daily, calpol x2 daily & baytril x2 daily. I’ve been giving her an occasional syringe or two of critical care just to keep her topped up as she is reluctant to eat pellets and hay, but she is eating all her veggies and forage – so so far, so good!

she is going back next week to get her stitches out and I think to take measurements of her heart to monitor it. Hopefully we get good news from that appointment and hear it’s not as bad as we thought it was

[Em]

I’m going to continue to update this thread as I’ve found it difficult to find others with the info I need, so in the off chance it helps somebody else:

 

good news and bad news. Good news is she is doing amazing, 100% back to her normal sassy self. She’s remained seizure free since her two episodes at the vet, so that’s also been great. Her nose is healing very well post rhinostomy, so hopefully we get a lot longer with clear breathing this time around.

bad news is that we had our appointment with the cardiologist who checked over her heart. So we had confirmation that she definitely has a mass by her tricuspid valve and that the right side of her heart is enlarged. They can’t determine as to whether or not it is cancerous without further testing, but I’ve declined all further tests as it’s not fair to her and it makes no difference whether it cancerous or not – as there would be no treatment either way, so no point in putting her through more pokes and prods than what she’s already endured (which is far more than her fair share). The good news, if there is some, from her heart scan is that she remains asymptomatic so doesn’t require any medication just yet and so far remains completely unbothered by it. Please God it stays that way, but I do acknowledge she’s an 8 year old rabbit at the end of the day. Still, each day is a blessing, and I cherish every moment I get with my orange ball of sass and fur. I’ll hold onto my slim hope that her mass is benign and leaves her alone. The fact that they advised a recheck in 6 months time gives me a bit of hope too that I’ll get to have her around for a while yet

[LBJ10]

Thank you for the update! I’m glad she is feeling better and acting like her old self again. I’m sure this was all quite the ordeal for her. Yes, she is 8 years old. But had she not gotten the CT scans, you would have never known about the mass on her heart anyway. She is asymptomatic, so you would have been oblivious. So enjoy your time with her as if you didn’t know anything was amiss. She clearly doesn’t know any different and I’m sure she is just happy to be home.

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