What's wrong with my bunny?

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EmilyS

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The summarized version:
My bunny, Nanook, is 9 has been very healthy up until very recently. This last week, he has been lethargic, sitting in a hunched position, and squinting his eyes. The last two days he also tilts his head left and drops his left ear when resting (not when alert). He acts almost normal when I come with veggies or other yummy things (like Oxbow Critical Care), but then settles back into that same pained position. He went to an exotic specialist on Tuesday who found nothing wrong in a physical exam or bloodwork. He was prescribed Meloxicam and Gabapentin. There was no improvement. I brought him to another vet with exotic experience (though not a specialist) several days later for a second opinion. He also found nothing.
Nanook is clearly in pain, and I suspect he is exhausted, but the vets can't find anything wrong. His appetite comes and goes, but on average is decreasing. I feel very lucky that he loves Critical Care, but I can't feed him that indefinitely. Any ideas would be greatly appreciated, because I am at a loss.

Known Medical issues:
Mild Heart Arrhythmia (his heart skips a beat about once a minute due tRo old age related changes in his heart) discovered Sep 2nd
Possible cryptorchidism on the right side discovered Dec 14th (he isn't neutered)

More medical history:
September 2nd: Very sudden and severe case of GI stasis (which in retrospect could have been a GI obstruction that cleared)
Nov 25th - Dec 10th: Intermittent mild-moderate GI stasis. Treated at home
Dec 11th: Stops eating hay. At first, he would put some in his mouth and then spit it back out. He hasn't eaten any hay since then.
Dec 12th: Brought him to non-exotic vet because he seemed to be in pain, despite eating plenty of Oxbow Critical Care. Prescribed meloxicam and made appointment with exotic vet.
Dec 14th: Vet did a full physical examination and found nothing. Physical exam was normal, and bloodwork was also normal. Prescribed additional meloxicam and gabapentin (which would be more effective for things like tooth pain than meloxicam). Suggests maybe doing an ultrasound for his cryptorchidism to determine he has a tumor, but the vet doesn't think that's a likely problem.
Dec 15th-Dec 18th: By now, he is eating pellets on his own, but spends most of the day squinting and in a hunched position. Medications seem to have little to no effect. Continues sitting in hunched position and squinting.
Dec 19th morning: Brought him to a non-specialist vet with exotic experience for a second opinion. The vet comes to exactly the same conclusion. Suggests maybe the medication could be hard on his digestive system and could be making Nanook lethargic.
Dec 18th-Dec 19th: Nanook starts tilting his head left when he is sitting and dropping his left ear. He stops tilting his head when called or when alert. It's subtle on the 18th, but obvious on the 19th.
 
Tilting the head would usually indicate pain somewhere in the head. And given that your rabbit also stopped wanting to chew hay, that is another indicator that the action of chewing is causing pain in the head somewhere. It could be from a dental issue, ear infection, or mass of some sort in the head. Was a thorough dental exam done? Were any xrays done, especially head xrays, but also of the body and chest area? Have antibiotics been tried at all?

Critical Care actually can be fed as an ongoing food supplement when needed. There are many cases of chronically ill or older rabbits that can't eat hard pellets or hay sometimes, and a soft food supplement is necessary. Though it definitely is more expensive. An alternative would be to make a soft mush out of your rabbits usual pellets by soaking the pellets in warm water, if chewing hard pellets is showing to be uncomfortable or a problem for your rabbit, and your rabbit will eat the pellet mush.
 
His head tilt disappeared after I convinced him to take a nap on me. Turns out sleeping sitting up is a terrible way to sleep, and makes you tired enough to drop your bunny head to one side. Why it was always to the left, I do not know.

A dental exam was done on multiple occasions, and though he has some small points and malocclusion, the vets though it wasn't anything that should be hurting him. He hasn't had antibiotics, however I believe infections would show up on the blood work in the form of white blood cell counts (but someone please correct me if I'm wrong). His white blood cell counts are the same as they were in September, when he went in for GI stasis. In any case, his ears have also been completely clean when checked.

He had a chest xray in September, but no xrays since.

I would also still suspect dental issues, because he still dives for food if I toss it to him, but then isn't interested. Or seems to sniff it and lick it and then abandon the food. The vets don't seem to think so, though. He doesn't show any signs of pain when his head and cheeks are massaged. If he had an abcess or infection, there would probably be some swelling and pain.

The only thing the vets suggested was doing an ultrasound to determine if he had a tumor due to his cryptorchidism, but they more or less admitted it was a shot in the dark more than anything.
 
It might not be infection but a problem with the tooth growth. A visual dental exam that isn't done under sedation and no xrays taken, means dental problems can't be ruled out as a possibility. There are some dental problems that can only be seen when the rabbit is sedated and the vet can get a really good look at the back of the mouth, as well as some problems that are below the surface and only xrays will show this.

Like overgrown tooth roots, which could be a possibility with your rabbit especially at his age, and might explain the initial interest of wanting to eat the food you offer but then leaving the food uneaten. Tooth roots can grow down or up into the jaw or facial bones, putting pressure on them and the surrounding tissue, causing pain, especially when trying to chew. Might be worth talking to your vet about a dental exam done under sedation, with xrays of the head to see if this is what's going on. Anytime a rabbit goes off food they normally would love and would eat eagerly(provided the food itself hasn't gone bad), makes me suspect a possible dental problem. Though another possibility could be unrelated to teeth, which could be stomach ulcers.

(contains medical related photos)
https://lbah.com/rabbit/rabbit-teeth-conditions/
 
He just pooped a whole string of mucus covered poops. I've never seen anything like it before. Could it be because he hasn't been chewing his food well enough? I took him off meds for 36 hours to see if it made a difference. There were too many confounding factors for me to say if it helped or not. I decided to give him some again this morning. Could they be irritating his digestive tract and causing this?
For a lot of reasons, I really don't want to take him back to the vet unless I have to.
 
Perhaps it isn't mucus? I guess I'm not sure what I'm looking for, but at the very least it was lots of large soft poops all strung together. It looks like cecotropes, but they are the size of normal poops
 
He's feeling much better this afternoon. Almost acting normal! ...except that he only eats critical care. His poops are hard again, but all shapes and sizes. Called my vet to request an x-ray of his teeth, but I'm still waiting to hear back.

Thank you for all your advice, JBun! Tooth pain seems very likely. He took a bit of treat from me eagerly, seemed to move it around in his mouth for 30-60 seconds without chewing, and then finally spit it out.
 

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