PROGNOSIS & TREATMENT

 

Over the course of 10 weeks, Opal was examined by three different doctors, all of whom had different opinions on how to treat this abscess.

 

VET #1:  Opal was officially diagnosed in July of 2010, with a jaw abscess.  The vet’s recommendation was to put Opal under anesthetic to clean out the abscess cavity; then remove her back molar (which was the source of her infection).  The estimated cost of surgery would be $500.  The vet was showed the information on injectable penicillin but she was very skeptical.  She said she never heard of this type of treatment and that it could be fatal if you puncture a blood vessel.  However, we did not take no for an answer.  This seemed the very best solution for two reasons; one – I simply could not afford the surgery, and two – surgery didn’t offer much hope.  After some discussion and against her advice, the vet prepared injections for the next 10 days at a cost of $18.00.  Opal was to receive an injection of Flo-cillin (a brand name for bicillin) every 48 hours in the abscess.  In addition, Opal was to receive oral pain medication in addition to oral probiotics.  Probiotics replenish the good bacteria in a rabbit’s GI track.  Since penicillin destroys all forms of bacteria, a rabbit can develop a condition causing flora imbalance which is another set of problems.  The brand name of probiotics used was Probios which I purchased at my local livestock store.  I paid about $7.00 for a 30-gram tube and it lasted approximately 3 weeks.  This product can also be purchased on line.  Another product you can use is bene-bac.

Opal’s response to treatment was most favorable.  I would say after day two of treatment, she was acting more like her old self.  After treatment #5, Opal’s abscess was noticeably smaller.  We were all so excited.  Opal had an easier time eating and had gained back some of the weight she previously lost.  Opal was becoming more active when let out of her cage.  But now, it is getting more difficult to hit the abscess.  Seven more days to go until our return trip to the vet.

It’s getting closer to our return trip to vet #1 and I’m having some doubts.  As I continue to education myself, I learned that injectable Penicillin G is not a new treatment for rabbit abscesses.  My doubts increased and I feel a loss of confidence in my vet because she did not appear to have knowledge sufficient to continue treatment.  So before Opal finished her first round of treatment, I found a new vet.

Vet #2:  After first speaking with vet #2 over the phone, his knowledge of all forms of abscess treatments convinced me that I was on the right track so I made an appointment for Opal’s second exam.  Vet #2 was not of the opinion that Opal’s molar should be extracted.  He explained that rabbits’ molars are very tricky to remove as their roots are curved into the jaw.  Because Opal’s abscess was connected to and in her jaw, it would be very possible, if not likely that during extraction, her jaw would break leaving Opal in a much more complicated condition.  He further explained that nature has a way of healing itself.  If the tooth root was destroyed, the tooth would eventually fall out.  If not, then Opal would keep her back molar.

Upon examination, vet #2 said that Opal’s back molar was, indeed, the source of her abscess.  He advised that both of her back molars needed to be trimmed, not extracted, as they were overgrown.  The vet invited my husband and I back to the operating room to watch the procedure.  The vet explained that the most effective way to trim her molars was to put Opal “under” anesthesia.  The safest way to do this was to let her breathe the anesthetic as opposed to inserting an IV catheter.  He placed a mask over her nose and mouth while I held her still.  As she continued breathing, Opal began to relax.  When her body was no longer tense, he quickly removed the large mask and replaced it with a smaller one to localize the anesthesia towards her nose.  When she was completely under, he removed the second mask and replaced it with a mask so small that it just fit over her nose. 

The technician held the mask in place while the vet completed the procedure.  First, he fastened a clamp to her upper and lower front teeth; then he proceeded to turn a knob cranking her mouth open (almost like a car jack).  Then he put an expander clamp sideways so he could open the mouth to its full capacity, getting the best view possible.  After her molars were clipped, he used two different files to flatten the teeth and file down the rough edges.  Once he removed the mask from Opal’s nose, it only took a few seconds for her to wake up.  The technician monitored her breathing and heart rate.  My Opal did great!  The whole procedure from start to finish took approximately 18 minutes.  The cost for the procedure was $228 – gulp!

Now that her teeth were finished and Opal was alert, the vet addressed her treatment.  He recommended injectable penicillin g Procaine.  Opal is to receive .2ml directly in the abscess every 24 hours and .35ml in the back between the shoulder blades every 48 hours.  She is to continue with her daily dose of probiotics.  The vet’s technician prepared the syringes for the next 21 days.  The cost of the 3 week treatment was $48.

Giving Opal shots was not what I thought it would be.  A bunny’s skin is tough, and I had to use a little force to get the needle through her skin.  It’s almost like giving a football a shot.  I did have trouble giving Opal her daily injections.  The plunger would not move after I inserted the needle into her skin.  After several days of wasting medication and getting both Opal and myself stressed, I learned that penicillin is a very thick substance and often becomes too thick when sitting inside a small needle hole making the flow through the needle impossible.  So, I contacted vet #2 and explained my situation, as well as the fact that it was becoming very difficult to inject Opal’s abscess because it reduced to the size of marble.  The vet suggested discontinuing the injections in the abscess but to continue the injections in her back every day.  He said it will probably take longer to eradicate the abscess, but from the beginning size of a golf ball to the size of a marble, Opal had come a long way.  I was to continue giving her oral probiotics daily.  Vet #2 supplied me with penicillin in small ampule vials and enough syringes to draw my own shots for the remainder of her first round of treatment.  Yet, I continued having difficulty.  When I applied pressure to the plunger, the syringe would explode with the needle/hub separating from the syringe.  I was wasting more medicine and the stress was overwhelming.  Again, I spoke to vet #2 who suggested a larger size gauge; meaning the needle hole is larger.  I went from a 25 gauge x ½” needle to a 20 gauge x ¾” needle — the smaller the gauge size; the larger the needle opening.  I could not believe the difference.  It definitely took care of the problem.  The medicine did not plug the needle and giving the shot took a matter of seconds.  It did, however, take a little while getting used to a longer needle, but it was worth it.

Opal received 1.5 ml of Probios everyday.  One thing to note, Probios is the consistency of creamy Vaseline.  The best way to get the probios into the syringe is to remove the plunger and squirt the substance directly into the syringe; then return the plunger.  Opal really likes the taste and eats it directly from the tip of the syringe.  For clean up, I have found that soaking the syringe and plunger in Dawn dish soap and hot water for an hour loosens the greasy substance from inside it.  After soaking, use a very small brush, like the one you use for cleaning an electric shaver, to remove the remaining substance.  Once all debris is removed, give the syringe a few squirts of clean hot water to remove all of the soap.  You are now ready for the next dose.  Do not put it in the dishwasher as it removes the measurement marks on the side.

After 3 weeks of treatment, Opal returned to vet #2.  He said that Opal still had some infection but was very pleased with her progress.  The abscess was almost gone and without surgery.  I was to continue treatment for another 3 weeks of .35 ml of injectable Penicillin G Procaine in the back and a dose of probiotics every day.  Now I’m faced with another problem.  How am I going to continue affording the vet and medication expenses?  My husband is off of work and we only have one income and the end of her treatment was nowhere in site.  Each vet visit costs $42; when the vet wants to check Opal’s molars, he has to anesthetize her costing another $138; the antibiotics, syringes and needles cost $48 for a three week supply.  I have already gone over the limit as to what I thought I could afford.  As much as I love Opal, I didn’t know if I could continue treatment.  I had to find a way to reduce my costs. 

Luckily, my local livestock/feed store supplies antibiotics so I was able to purchase the penicillin from them as well as the needles.  The cost for a small bottle (100 ml) of injectable penicillin g Procaine cost $9.00.  The bottle is quite large and it is going be enough for the remainder of Opal’s treatment.  As a matter of fact, the bottle is so large that it could have supplied treatment for 10 bunnies with abscess.  Vet #2 supplied the 1cc syringes at no charge – I only needed a few since I washed them out after use.  The price for a package of 21needles (20 gauge x ¾”) was $5.00; total treatment cost $14 plus tax.  I was able to continue treatment for another 3 weeks and then returned to the vet.

Vet #2 told us that the abscess was completely eradicated.  He could not feel anything!  The only thing he wanted to check were her molars, the cost $228 which included the office visit.  I just didn’t have the money and told the vet so.  He said he was sorry but could help me no further.  But it kept bothering me and I just had to find out if Opal needed her molars trimmed again.  Since her abscess had been eradicated, I felt I owed it to Opal to find a vet whose prices I could afford under my difficult financial circumstances.  So it was back to the drawing board in finding another vet.

Vet #3:  After much diligent searching, I found an affordable vet.  Opal was examined once again, but vet #3 detected still more infection in Opal’s gums.  When she pressed Opal’s chin in an upward movement, a small amount of pus oozed from her bottom incisors.  She was not sure if this substance was the tail end of abscess material or from gingivitis.  I asked if Opal was to resume treatment of injectable penicillin, but she did not think so.  However, Opal did need some trim work on her right molar to remove a tooth spur; the left molar was fine.  Vet #3 was able to use a tool to snip off the spur that irritated her tongue.  She told me she would attempt to do this without the use of anesthetic.  Opal was wrapped in a towel and taken to the operating room for the procedure.  The vet returned with Opal and said she was a champ.  She was able to remove the spur successfully.  Cost of vet bill, including procedure, $98.  Vet #3 wants to see Opal the beginning of the year to examine her back molars to make sure there are no spurs.  We have an appointment January 15, 2011.

But for now, Opal is doing great!  There is no sign of abscess.  Opal is active and eating very well.  I will continue to post about Opal’s continued care and any further changes in her health.

In Summary

 

What I have learned is that you have to be your pet’s advocate.  Learn all about your pet’s condition by finding reasonable and affordable solutions.

Interview veterinarians over the phone and gather as much information as you can before you make that appointment.  Sometimes, time is of the essence and better to find out, over the phone, that a vet will be unable to help than to go and make the appointment only to find out that the vet is unaware of certain treatments or is unwilling to try.  Be pretty comfortable and confident about your vet selection. 

Use your instincts; we were blessed with them to help us make good decisions.  Only you know your pet.  Remember, all decisions rest with you.

Don’t take no for an answer.  All of the vets I visited are good vets, and they all brought something to the table in Opal’s treatment.  Without all of their input and all of the information on the Internet and all of the people I spoke with who had similar experiences, I would not have been able to make the decisions necessary for Opal’s care.

Whenever possible, purchase your medication from a feed/livestock store or on-line as opposed to purchasing it from your vet.  It really reduces your costs dramatically, and don’t feel guilty about it either.  Somewhere down the line, you may need that savings to use for future treatment.

The most important thing is this: DON’T GIVE UP.  There are answers for you at a price you can afford.  There are many rabbit owners who have stories you will be able to relate to, offering hope and good advice.  Educate yourself; it’s your most powerful tool.  Don’t settle for your pet’s demise or a gloom and doom outlook.  There will, of course, come a time when your pet will pass on.  Sometimes the prognosis will not be good, but I have made a resolve that if Opal dies or needs to be put to sleep, it is better that I tried everything I could, than to do nothing at all.

In the end, Opal never needed surgery.  Her abscess never returned and she continues to live the “Life of Riley”.