My rabbit Budja's jaw abscess came back for the third time after 2 surgeries

[Cassie119300]

Hello,

Around September this year my rabbit Budja's developed a jaw abscess along with excessive chewing motions. She was prescribed Baytril and Meloxicam leading up to the time of the surgery and really had a hard time with the first abscess as there was a little hole in her cheek that was not found until the time of the surgery, that hole in her cheek acted as a sort of duct that communicated with the abscess on the outside of her mouth, she also had a dental done at the same time where some teeth were grinded down other than that they didn't seem too bad. When it became more difficult and she was eating less and less the vet opted to do the surgery sooner and the next day. I really had a hard time giving her both the baytril and azithromycin so the vet opted to give her an injection of Penicillin G that would last all week to make up for the Azithromycin. She got her sutures out just 3 days over the recommended two week timeframe, all was good, for about a month that is. She never really stopped the continuous chewing motions though. The second abscess developed just under her jaw bone this time and at this point the vet recommended getting her an x-ray and keeping the baytril and azithromycin going if possible. She did start to take the azithromycin for me however, her stomach did not agree with it so she had to be taken off of it and continued on the baytril and meloxicam. This time during the surgery a biopsy was done as well as both an aerobic and anaerobic culture. The x-rays were looked over and no abnormality was found, no connection of the abscess being into the bone, or any abnormal tooth issue, or anything showed up, just an abscess that was not connected to anything. For both surgeries the abscess and the abscess capsule have been entirely removed. The aerobic culture came back showing it was staph bacteria that is sensitive to penicillin and chloramphenicol. Unfortunately, not even 6-7 days after this surgery Budja's developed another abscess nearly in the same exact area underneath her chin/over some of the cheek bone yet again on the right side of her jaw and it's a pretty decent size again as well. It's just near where she just had her sutures taking out yesterday. So the vet sent for some chloramphenicol that has to be crushed and compounded which should be in for me to pick up next week (this place is an hour away) and she has also recommended that I now get Budja's a C-T scan at Cornell University, that's about an hour away as well but pretty out of the way. Affording this is getting pretty hard now.

I'm continuing on the Baytril and Metacam knowing its not doing any bit of good, for some reason the vet had me stop the baytril 7 days after this last surgery but restarted. There seems to be no probably cause for the issue and yet Budja's continues to do that chewing motion as if she has peanut butter stuck in her mouth she is swishing around or something. Totally stumped on what could be the issue. She also likes to lick her stuffed bunny excessively and her blankets. When I first got her I did notice her left eye had some tears and stuff like an overproduction but I haven't seen that happen since, I only noticed when my hand had touched it when I pet her. Not so much for this right side though. I just keep thinking it absolutely has to be something dental related or some foreign splinter they still haven't found yet. Does anyone have any experience with this? My vet thinks that Penicillin G once a week would be enough but it wouldn't be easy for me to go back and forth an hour each week and I'm not even sure for how long she'd want me to, but she also seems guarded now about me giving them at home to budja's as I'd have to learn how etc even though I'm willing, it just makes more sense to me, so not really sure what she wanted to do/not do regarding that, but I did have her give her a shot yesterday that lasts a week. I talked to the vet about using bicillin she is concerned about it creating a lot of sterile abcesses as it has to be injected every other day and I sent her information on it. I asked if the cloraphemincol would be enough to take down the abscess and the vet did not know, basically nothing is clear on this... the vet and I are both stumped. The vet did say however that we are also looking at another surgery and we are still waiting on the anaerobic results. I did ask about the possibility of putting antibiotic beads in the surgery site when the abscess is next removed, they did say it was possible, but I'm thinking what if her body rejects it and then it forms another abscess. She did look in her mouth yesterday with her tool and didn't see anything.

Does anyone have any ideas??? I have also attached a video of her chewing motions and a scabby area where the incisions were just removed where is where the new abscess formed again just underneath.

Thanks

 

[JBun]

That odd chewing behavior does seem to point to there being some sort of problem still in the mouth. Though that could just be from the discomfort the abscess is causing.

Pen g once a week is definitely not enough. Pen g procaine has to be injected every day, and pen g procaine benzathine(eg. bicillin) needs to be injected once every 2-3 days. If it was only being given once a week, that can be an explanation for the ineffectiveness of it. Sterile abscess is a possibility, though if done correctly, it's less likely to happen. There are plenty of rabbits that have have pen g injections, with no instances of sterile abscesses occurring.

Successful Eradication of Severe Abscesses in Rabbits with Long- Term Administration of Penicillin G Benzathine/Penicillin G Procaine

I had the best success getting rid of abscesses and infections in my rabbits using azithromycin, but since your rabbit reacts negatively to it, that's not an option. Hopefully you'll see better results with the chloramphenicol.

Since you will be starting the chloramphenicol soon, it's worth giving it a try. Maybe it will prove to be the right antibiotic for this infection. Though I would suggest making sure an effective dosage is prescribed and for a long enough length of time. Infections in rabbits can sometimes take months to clear up, and less experienced vets will often not prescribe a long enough course of antibiotics, so the infection just returns once the medication is stopped. My rabbit with an abscess, had to be on high dose azithromycin for a month to get rid of the infection, and azithromycin is pretty heavy duty and usually only prescribed for a week.

So it's making sure if you are seeing improvement with an antibiotic that it's continued long enough past the last of the symptoms clearing up, that it really has gotten rid of it. For my rabbit it took 3 weeks past most of the signs of infection being gone. We had tried azithromycin at the lower dose and for only 2-2.5 weeks, and the infection came back once the antibiotic was stopped. So upping the dosage and doubling the length of the course ended up being what was needed for my rabbits infection.

I've found it's important to do my own research on treatment and meds, and to always discuss my concerns with a trusted rabbit vet. If you don't feel something is working or the treatment isn't enough, bring it up with your vet, or even get a second opinion. Dental abscesses are very difficult, and treatment has to be pretty aggressive or it's just going to keep coming back. But most important is having the best rabbit vet available, helping you to work out the best treatment options for your rabbit.

Medirabbit: facial abscesses

Medirabbit: abscess management

https://rabbit.org/veterinarians/

 

[Cassie119300]

Hey, I know this may sound silly, but maybe the reason nothing can be found, if there is some foreign object in there, is because the x-ray was done with the abscess present? Maybe... it's something that's only going to be visible when that abscess is out. Then again, like you said it could just be the discomfort, she did the same thing after both surgeries were done as well. There has just been periods in between where that stopped (between the 1st surgery and second abscess formed was when it kind of stopped) Budja's is notorious for getting her mouth on anything/everything she can chew let's just say I had to completely cover my box spring of my bed with metal cube grate things. I did send that very exact article over to the vet seeing Budja's, not sure what the idea is on the injections or not yet, I wanted to try and learn how so I could do them but it could be very difficult to impossible with my rabbit with how jumpy she is, I think they even have a pretty hard time with her as well. So I hope this stuff is enough, if this abscess truly... is not being caused by anything foreign and this medicine can penetrate bone areas.. maybe just maybe. That would be awesome. I don't know if this is anything related either but I do notice she keeps getting some cecotroph smudge on the corner of her lips and seems to be grabbing cecotrophs quite a few times during the day, is that normal?

Thank you for your input on this, we'll see how it all goes.

 

[Cassie119300]

So I think since the C-T and consultation at Cornell is not an option price wise, pretty pricey... we will be going ahead with seeing if some Bicillin can be ordered and undergoing another abscess surgery. I decided against the chloramphenicol as it is kind of hazardous to human health. Hoping this will be enough.