(RIP) Mr. Bun in Acapulco has a Jaw Abcess

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Hi,

I think you have received a lot of good tips. I treat abscesses very aggressively. Would it be possible for your vet to e-mail me so I can give him/her some detailed information on dealing with an abscess....including detailed dosing protocols.

The version of penicillin you are using is weaker than the version we have in the US. I would probably use the .4 dosing every day for a few days. This drug should be used sub-q in a rabbit. It is extremely painful administered IM. It is still uncomfortable even sub-q. I usually buffer it with some fluids as was mentioned. In fact, he probably needs fluids anyway...up to 5%. This should be used in conjunction with Zithromax. The dosing for Zithromax in a rabbit is much higher than with dogs. The combination of these drugs have the ability to penetrate to the core of the abscess and attack the anaerobic bacteria. Culturing an abscess usually results in a growth....but that is not the bacteria that should be attacked. The drugs in that version of Pencillin are perfect for treating an abscess. The procaine aspect is a fast acting drug and attacks the bacteria literally within hours...but it has a short life. The Benzathine aspect takes longer to reach working levels but stays there longer. When Pen was first used, it was used once a week. Now, most use it every other day. I normally use it once a day for 3 days and then every other day. That keeps the Procaine aspect at a higher level until the Benzathine can get up to speed. The injection points should be moved around...don't inject near the same points. This drug can lead to some sterile skin abscesses (they are just scab overs from the irritation from the drug). There is another drug, Chloramphenicol, that is also very effective at penetrating a walled off infection. For an adult rabbit, it is a relatively safe drug (keeping in mind that any medical treatment carries risks) but there is more of a possibility for side effects for the human that is handling the drug. Some people develop a condition called Aplastic Anemia (Bone Marrow Supression) but it's rare. Gloves and hand washing are proper protocols when using this drug.

Pain management is vital. Metacam is rough on the liver and kidneys so proper hydration is essential. That dosing seems a little low so if you know the concentration of the Metacam, I can formulate it for you. There are two concentrations normally used in small animals and to get the correct dosing, I need to know the concentration. Your rabbit needs a narcotic aspect. Buprenorphine is the best. Tramadol is acceptable. Initially I would up the hydration and use the Metacam and a narcotic concurrently. I sometimes sedate with valium early in the event until I can get the pain properly managed.

I wouldn't sweat the food right now. I am sure he is dehydrated. Feeding a dehydrated animal only makes the dehydration worse. Syringe feed an electrolyte solution (Pedialyte for human babies is a good one). Plain water is better than nothing. Get him hydrated and then work on offering food.

See if your vet would be willing to talk with me. If he/she can speak English....I will talk with them by phone if necessary. I think at this point your rabbit is in significant pain. The infection also compromises the bone structure and the quicker it gets resolved, the less chance for collateral issues related to the infection.

Has your vet done any radiographs of the jaw? Most dental abscesses are caused by molar root impactions..but there can be other causes. If you have some digital rads, see if you can e-mail me a copy and I will take a look at them. I do not open an abscess. The old school way of dealing with an abscess is to lance it. At one time there was an idea that looked good on paper but didn't work so well and that was packing antibiotic laced beads directly into the abscess. Extensive surgery and debridement is a very difficult surgery even for the most experienced vet not to mention the pain and stress to the rabbit. I have treated numerous abscesses here and have never opened one.

We have a huge snow storm here today so I will be able to check back on the forum fairly often. Or you can send me a PM if you would like. I suggest getting much more aggressive in treatment.

Randy
 
Thank you Randy for sharing your wealth of knowledge. As I was always in my school-days.............I am THRILLED to know about your SNOW DAY knowing that I'll be able to find you there with any questions later in the day when I am with my local vet.

Mr. Bun started leaving more and more of his greens late December.........producing very little fecal matter. I had been away from home over the holidays, but noticed this within the first few days I was home. It was New Year´s and there were no veterinary clinics open so I syringe fed him for 48 hours with lots of water until I could get him in to see a vet. I was worried about G.I. stasis, but hadn't even thought that this might be a problem in the mouth.............DUH! Probably because the only Rabbit-Savvy vet who checked him during a visit to Acapulco told me he had excellent teeth! Anyway, Vet No. 2 discovered the lump on his jawbone and put him on .3ml of Shotopen I.M. every 48 hours for 6 days. 3 drops of Metacam every 12 hours for the first day and 3 drops of Metacam every 24 hours after that. I asked him to do an x-ray. He said "Let's see how he does with the meds first." I took Bunny back 6 days later when there was no improvement. I insisted on an x-ray and he told me that he didn't want to stress Mr. Bun any more than he already was and he changed his meds to ORAL CLINDAMICINA!!!! I changed vets!

Mr. Bun is now being seen by Dr. Rosy. She is not Rabbit-savvy but is young and very willing to learn and she likes having Mr. Bun come to visit her. Since January 9th she has had him on the Shotopen (.3ml) injections every other day and added .5ml of Enrofloxacin (subcutaneous) every 24 hours. We continued with the Metacam (3 drops every 24 hours.) I have yet to see any improvement. He eats little and only from the syringe. He drinks only from the syringe. He seems content having the extra attention.............he actually is allowing me to hold him for long periods of time!
Metacam Formula: 1 ml contains 1.5 mg of meloxicam. 1 drop contains 0.05 mg of meloxicam.

I took Rosy the article written by Marcy Moore yesterday and had her recalculate the Shotopen. She was very concerned about giving it subcutaneously as she had never done that and the indications on the label are for intramuscular injections. It is a milky white substance that is not oil based, so I am assuming we can go ahead with subcutaneous injections? There is an added component to Shotapen that is not contained in Bicillin: Rosy was had no knowledge about the "Dihidroestreptomicina base" for rabbits???? Please advise.

Antibiótico de amplio espectro en suspensión inyectable. Contenido Neto: 100 y 250 ml
Fórmula: Cada 1 ml contiene: Penicilina G procaína 100,000 UI Penicilina G benzatínica 100,000 UI Dihidroestreptomicina base 200 mg Excipiente c.b.p. 1 ml
Should we stay on the enrofloxacin? I am going to go back now to your post to see what other questions come up.............about fluids and the other antibiotic you mentioned. I'll be back here soon.........Hopefully before the inauguration! ; )

Thank you again. You all are a LIFELINE for Mr. Bun and I. (He is much more alert today than he was yesterday.) But I think you are right, he must be dehydrated, even though I have been pushing fluids...........about 15 ml every 4 or 5 times a day. I have not wanted to give pedialyte because it tends to irritate the stomach's of my dogs? Do you give it full strength? How much for a 2.5 kg bun? Sorry for such a long post..............Marna

 
ra7751 wrote:
"The version of penicillin you are using is weaker than the version we have in the US. I would probably use the .4 dosing every day for a few days. This drug should be used sub-q in a rabbit. It is extremely painful administered IM. It is still uncomfortable even sub-q. I usually buffer it with some fluids as was mentioned. In fact, he probably needs fluids anyway...up to 5%."

These fluids go in subcutaneous also, right? When you say 5%, I know that Rosy will understand that but I don't so could you please explain? Should these be a saline solution?

"This should be used in conjunction with Zithromax. The dosing for Zithromax in a rabbit is much higher than with dogs. The combination of these drugs have the ability to penetrate to the core of the abscess and attack the anaerobic bacteria."

I don't know about a veterinary presentation but we can get Zithromax here in tablet form for Humans. Not sure how I should administer this to Mr. Bun?

"The injection points should be moved around...don't inject near the same points. This drug can lead to some sterile skin abscesses (they are just scab overs from the irritation from the drug). "

Always with fluids I assume? Randy, should these fluids be mixed in the same syringe or should Mr. Bun be hooked up to an I.V. for subcutaneous administering of the shotopen. I don't know if my question is clear, but I hope you understand!

Thank You!!!
Marna
 
Umm....the version of Pen I have doesn't have that component. The best I can tell is that it is some form of Streptomycin. That drug is considered safe as an injectable but is rough on the kidneys and can have some negative effects on the ears of all places. I would leave that up to your vet....maybe she can put out a post on the VIN and get some responses from other vets just to be sure. This might be a case of having to choose the lesser of the evils. Since I don't know what is available in your area, I really can't offer an alternative. But Chloramphenicol might be a possibility. I would suggestdropping the Enrofloxacin (Baytril). It has gotten to the point that family of drugs is of very little, if any, use in rabbits. The calculated dosage of Metacam is appropriate....I just don't usually do it in drops. If you use a syringe, the dose would be .16cc. I don't normally give dosing on the forum but it is quite easy for anyone to figure that one out based on the info provided. I would get the Zithromax going as well as more aggressive pain meds. And treatment will take time.

Clindamycin??? I am glad you had on your running shoes and were well educated. I don't even use that one. The problem with using that drug is that it is an almost "kill all". It will kill all the bacteria except Clostridium....and that bacteria is resistant and that bacteria will kill a rabbit when it is present in large numbers. Good job....a golden cottontail to you for being well versed. And I must say that I am impressed with your knowledge...obvious you have been doing research.

Randy
 
We were posting at the same time. To answer your questions...

There is a test the vet can do for dehydration. We normally hydrate at 5% of body weight. With most rabbits, I use Lactated Ringers since it contains electrolytes that are lost in infections. I also use Sodium Chloride too.

The Zithromax is the human drug. I compound my own using the powder. But it is also available in a children's suspension that is quite tasty and most rabbits will take it right down. If your vet can't find the dosage by using the VIN, let me know and I will send it to her.

I mix the Pen in with the fluids. This will buffer the burn and reduce the chances of a skin absess. It also dilutes that thick drug. If you use a drip infusion, the drug can be injected right into the line during the drip. I "push" fluids by using a large syringe and a butterfly cathter. I can infuse a large amout of fluids in just a few moments. That is important in wildlife since it really stresses them....plus if you are working with the business end of a raptor or, as I am doing now, a rather large snapping turtle....things need to go quickly. It is important to use a luer lock to prevent a blow out.
 
Pedialyte is used all the time on this forum for our rabbits...we can get unflavored here but if you cannot get it or if Mr Bun won't drink it get a flavor. It doesn't need to be pedialyte but an electrolyte drink for babies (often generic brands are sold)
I will give you a chart and if you look carefully you can find pedailyte listed. ..enter in Mr Bun's weight and it will give you an average of the amount over a 24 hr period.


Don't worry about the exact amount. What is important is giving small amounts very often in a way that will not stress Mr Bun. if he likes the taste he probably will drink more.
I have a rabbit with dental issues who drinks it out of the syringe in cherry flavor.


I am glad that Randy is helping now.

He taught me how to give bicillin although I do not have the more sophisticated medical equipment that he does (I use syringes and needles)
Hopefully your vet could teach you to give subqutaneous fluid so you could give Mr bun fluid under the skin.



http://homepage.mac.com/mattocks/morfz/rx/drugcalc.html

We had a rabbit recently that had surgery for his abscess and was on bicillin. Unforunately this rabbit did not make it. The owner felt that the extent of the surgery(weakened him ) although he no longer had a jaw abscess


Randy doesn't believe that surgery is necessary to cure a jaw abscess.

I am going to post the links for abscesses. There is a lot of good info in here. One of the most recent abscess cases on the forum is the very last article on the entire page which states 'graphic" photos"


http://www.rabbitsonline.net/view_topic.php?id=11791&forum_id=10

this rabbit did have surgery which his owner felt was to much for him .. Randy has posted a lot of good info in thisthread
please continue to let us know how Mr Bun is doing
 
OK, now that we are through the Inauguration ; ) I can get back to work. Randy, I would like you to know that there is a "human" medication here that is called "Benzetacil" that is similar to the composition of Bicillin................not exact but maybe closer??? The formula is: BENZETACIL COMBINADO .

Suspension inyectable:
Bencilpenicilina benzatínica 600,000 U
Bencilpenicilina procaínica 300,000 U
Bencilpenicilina sódica 300,000 U

Each application with dilution contains 3.0 or 5.0 ml of injectable water
[align=justify] SUSPENSIÓN[size=]inyectable:[size=]
[size=Cada frasco ámpula contiene:][size=]
[size=Bencilpenicilina benzatínica]600,000 U
[size=Bencilpenicilina procaínica]300,000 U
[size=Bencilpenicilina sódica]300,000 U
[size=Cada ampolleta con diluente contiene:][size=]
[size=Agua inyectable]3.0 ó 5.0 ml
[/align]
 
Unfortunately I didn't pay close enough attention to my Spanish in school....so needless to say, I have some trouble with interpretations. So I would disuss this with your vet. It seems that form of Pen you found is a Benzylpenicillin. Specifically it's Pen G Sodium. Apparently, again relying on my limited Spanish, appears to be effective against Gram Positive and some Gram Negative Cocci bacteria. That is a very concentrated drug. Honestly, I would have to do some research to give you a definite answer...but my gut feeling is that it should work at a proper dosing. I would ask your vet to do some research on this too.

From what I find out from my human medical people, most forms ofearlypenicillin are not used for humansin the US due to resistant bacteria along with the fact that the more modern drugs usually carry fewer side effects. Chloramphenicol is another that is no longer used in the US except in some very unusual cases in which all other means have been exhausted.

I will do some research this afternoon and see what I can find.

Randy
 
angieluv wrote:
I will give you a chart and if you look carefully you can find pedailyte listed. ..enter in Mr Bun's weight and it will give you an average of the amount over a 24 hr
WOW!!! No wonder Mr. Bun is probably dehydrated!!! The chart states that I should be giving 187 ml per day. Poor little guy. I think he'd be lucky if he was getting 1/3 that amount of daily liquids. We'll start SQ fluids TODAY for sure.

The good news is Mr. Bun seems a little more animated today. He must know how many GREAT FRIENDS he has pulling together to help him feel better.

Thank you to all!
Marna and Mr. Bun
 
Maureen, did you receive my private post? I hope I "sent" it..........?????
 
Randy, if you have a chance could you please send me the formula how to calculate the dosage of Zithromax for a bunny that weighs 2.5 kg. I was able to find "Azitromacina" here in Mexico which is the same medication. The formula is: Powder for 22.5 ml once the medication has been mixed. Each 5ml contains 200 mg of Azitromicina.

Also, I need to ask you, using your 5% recommendation for hydration, I calculated with my vet 125 ml. She thought that was a very large quantity to put into such a small bun, and she wasn't sure if the fluid should be applied all at the same site, forming a "bunch-back of Notre Dame" or if we should use several sites???? She decided to hydrate with just 20ml of Lactated Ringers (Harmen) into which she added the .25 ml Benzetacil Combinado. I will push more liquid the rest of the night but I am a little confused about this quantity also???

How 'bout that inauguration? ; )

Saludos,
Marna
 
How is Mr. Bun?

Been thinking about him all day.

Hope he's doing okay.



sas :?
 
Buenas Noches "sas". I am going to copy you here what I just wrote to Randy in a private post. I am in TOTAL SHOCK at what I found in Mr. Bun's mouth today while we were visiting my vet for his Vitamin B shot and his SQ fluids. His bottom front teeth are TOTALLY, TOTALLY misaligned with his top teeth!!! He has always had a perfect "bite"...........he was checked by a rabbit-savvy vet about a year ago and she told me that with a "bite like his" I would probably never have dental issues with him!!! Even a week ago, his teeth were perfectly aligned in front!!! How could this happen? He has not wanted to drink anything today...........not even from a syringe. : ( He has however tonight lapped away at his slurried pellets. Now I am very worried. Can an abscessed jaw bone do this? I've been reading this evening that the signs and symptoms of malocclusion are excessive drooling, (which he started yesterday) and a jaw bone which "appears very swollen!!!!" Maybe we don't have an abscess after all? I'm confused tonight and don't exactly know how I'm going to proceed with this situation now. I'm thinking we need to get to Mexico City with him very soon to try and find a veterinarian there who can do a thorough dental exam on him and know what they are looking at. : ( Any suggestions? I know I need an x-ray now, IMMEDIATELY but I've been afraid to sedate Mr. Bun in the delicate state of health that he is in. Thanks for "listening" to me think out loud!!!
Saludos. Marna and Mr. Bun.
 
It sounds to me as if the abscess in his jaw could be the result of something going on inside his mouth...like infected tooth roots or some other anomaly that you can not see with his molars

I'm sure that Randy has given advice to youre. seeking outsomeone who can do dental work, getting x-rays of his mouth etc.
This is the kind of issues that i am dealing with my bun, Beau who I mentioned is on bicillin. he has advanced periodontal disease, tooth root infections , teeth growing in odd direction including into his cheek. etc

he recently has had a bad eye infection which most likely is the result of the infected molars beneath the eye on the upper left side.

He is having his teeth done on the 28th after many postponemments due to not being able to travel with the snow storms that we have been having.

teeth grow fast in rabbits...almost like our finger and toenails

hope that you can get a good vet that can do dental in Mexico city

Maureen
 
Hi Maureen. I am taking Mr. Bun this morning for some x-rays. If the vet determines that it would be better to sedate him rather than "trance" him (which he does very well by the way!) then maybe we'll get a better look at what is going on in that tiny little mouth of his. This misalignment happened almost "overnight"............and I'm wondering if we can get the jaw swelling down, if the jaw can move back into place??? Going to look for a feeding tube also............as he is now getting squirmish with the syringe. What is pretty amazing to me also is the fact that although his food and fluid intake seems so limited, he hasn't really lost any weight although he looks thin to me...............We gave him 20 ml of fluids two nights ago and 60 ml last night. Maybe he's just retaining all of that, but even before, he had only gone from 2.67 kgs to 2.50............so he must be "sneaking" a few calories when I'm not looking. : ) I'll let you all know what the x-rays show............if only the vet here will know how to read them. Sending some ear and tummy rubs for your little Beau!
Marna and Mr. Bun.
 
Just wanted to say you've received some great advice.

If you have time, check out our library section on Abscesses. My Max had a horrible jaw abscess. We eventually had it surgically removed bc it was creating very severe breathing problems. In addition, he was on Bicillin and pain meds for months.

You might ask about a stronger pain med than Metacam. I can tell you from observing Max that jaw abscesses are extremely painful. For feeding, I always crushed Max's pellets up and mixed them with water or some children's pedialyte, then either syringed the food to him or he ate it off a spoon. The main thing is to keep him hydrated.

Sending lots of prayers your way. Youre such an awesome person for doing so much to care for Mr. Bun when your resources are so limited.

*hugs*

Haley
 
Poor Mr. Bun. It does sound to me like it could be a tooth root issue, so sedation and an x-ray is best. I'm glad you're taking such good care of him.
 
Marna, I hope you don't mind, but I'm copying the information from Bon's thread in here. It gives good background and both your stories will help others.



marnarojas wrote:
Hello Bon, My name is Marna Rojas. I am an American,living in Acapulco, Mexico andsharing life with a beautiful little 2.5 year old New Zealand White named Mr. Bun. Since the New Year we have been battling an abscess under his jawline with much help from this list..........Randy and Maureen and Sas have been soooooo helpful and encouraging. They directed me to Gizmo's story and I have just read through it from beginning to end. I am at a loss for words and now, months later share with you in your sorrow for having lost your special little friend.:bigtears:Your journal and photos have helped me greatly as we have no rabbit-savvy vets here in Acapulco. We have been following the bacillin/zothramax protocol for the last week. Before that we were on Shotapen which is similar to bacillin but has another added component. We drew off 5 ml of puss and fluid on Friday night and Mr. Bun seemed to get some much needed relief but now 2 days later that abscess is filling right back up and fast!!!! So I think I will need to have it lanced tomorrow ASAP and begin the whole process that you so carefully detailed in your posts. Gizmo is our HERO and TEACHER. I have been crying all weekend thinking that it probably would be better to help Mr. Bun hop out of this life peacefully rather than put him through surgery and all that after care, but you have shown us that where there is a will there is a way and our little bunnies are definitely worth fighting for and I think as long as they see our caring efforts, they continue to fight. But I am so fearful Bon, and I'm wondering if you can shed any light on what may have cause such a rapid deterioration in Gizmo's state of health? What should I look for? I'm sorry to be perhaps opening up a painful wound again, and if you prefer not to go there I understand completely.

To you and your precious Gizmo RIP............MUCHAS GRACIAS

Marna and Mr. Bun


Bon wrote:

Hi there, sorry to hear about your problems, and im glad Gizmo can still help others even now.



I think the key word is nutrition, due to the location of the abscess eating will be very painful, and I think that although Gizmo was eating, it just wasn't enough or enough of the right stuff.

Before you start down the road I did, be fully prepaired, have the following at hand.



Strong daily painkillers

Critical Care (http://www.lambertvetsupply.com/Critical-Care-1-pound--pr--015OXP011)

Sterile equipment and surfaces.

Digital Weighing scales.





The main thing is to make it as quick as possible. I won't lie, it is a horrible thing to do, but ask your vet to open it up as big as possible. If you only have a small wound to clean through it will become blocked up with puss as well as the skin trying to heal neading daily re-openings, not pleasent for you or your bun.

I normally gave Gizmo the painkillers an hour before doing the rest.

My other thread shows how I did it, on top of that I would reccommend using critical care to assist in feeding and weigh the rabbit daily, note down the weight somewhere so you can make sure he isnt loosing any.



Final point, be prepaired to give your bun lots of love and attention. I still miss Gizmo so much and wish I could have only had more time.

Good luck.

 
Yes, by all means, I am Happy to share any information that might help someone else with a problem similar to Mr. Bun's!

And I am also very happy to report to all of you that I believe that Mr. Bun has FINALLY turned the corner. Not counting victory yet, but yesterday morning I noticed that the abscess appeared to be just a little smaller..............I thought it might be my imagination, but the vet whom we are seeing confirmed it for me. :) I have been so overwhelmed with the decision process of whether to do surgery or not................but I hung on to the hope, that as Randy stressed to me time and time again........."You've got to give that Bicillin/Zothrimax protocol a chance to work. It took exactly 8 days on the new treatment but that golf ball of an abscess is definitely smaller. We did draw off almost 5 ml of fluid from the spot on Friday night, but the next day, the abscess appeared just as big!

One observation that I made was that with the excessive drooling that started a week ago, some of that Zithromax just got dribbled out of the corners of his mouth, soaking his neck fur. Since Saturday I have been much more careful with the way I syringe that medication, giving him more time to swallow.

Since Sunday, Mr. Bun seems much more interested in his softened pellets............eating them several times a day now, and he seems much more active. I'm giving him Metacam and Tramadol for the pain. He seems to have developed a little sterile abscess at yesterday's injection site, but we are not going to blame his vet. ; ) And the next time we go, we will take extra sterile needles so they can be changed after drawing antibiotic from the vial.

After having been syringe fed for the last 3 weeks, I'm sure Mr. Bun's molars are in need of urgent attention, so I will be taking him to Mexico City this week for his FIRST DENTAL EXAM! His diet has consisted mostly of hay, freshened daily and big green salads with some yummy carrots. I give him pellets only occasionally............. so I will be very interested to see what the dentist finds when he manages to get that sweet little mouth open.

The drooling seems to have lessened but do any of you have advise how to comfortably clean that fur under his neck that has become so matted and wet? His skin there looks very irritated and because it is where the abscess is I don't want to cause any more trauma there.

As always, thank you so much for welcoming Mr. Bun and I to this list. We feel so fortunate to have found a space with so many generous bunny-friendly people offering encouragement. We will continue to keep you all updated.

Marna and Mr. Bun (Thank you fo aw yoe hewp. My wittoe mouf feews awot bettoe.)
 

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