Bunday Blog Business: Epinette's Battle with Pneumonia

It's been a long time since we did a Bunday Blog Business.  Most of the time, Epinette and I (Pippin) are just so busy with relaxing on the couch and eating hay that we really just can't get motivated to write a blog post.  The rest of the time I am busy doing audits, like garbage can audits and closet audits and hay feeder audits and audits under the couch.  It's exhausting.  The female hoomin bean (FHB) said we should do one anyway.  So, we are going to blog about a difficult subject today, and that is the subject of Epinette's health.

Sometime in early February, the FHB noticed that Epinette was sneezing a bit.  She thought it was because there was dust in the hay bale.  She took a close look at Epinette and there was nothing coming out of her nose, so the FHB didn't think it was too serious.  There was more sneezing.  The FHB thought maybe she had an allergy to a plant in the hay.  She looked at Epinette's nose again.  There was still nothing, but the FHB decided that Epinette was maybe starting to have a little trouble with breathing, so the FHB decided that it was time to go to the vet.

Epinette went to the vet on February 22, and she came home with some medication called Enrofloxacin, which is also called Baytril.  The FHB was putting it on fresh kale and snow peas, and feeding it to Epinette.  I wasn't getting any.  I didn't think this was fair.  Why wasn't I getting this treat on my snow peas?  The FHB said I didn't "need" it because I wasn't sick.  The vet had said that Epinette had a respiratory infection.  The Baytril was an antibiotic to make her get better.

She didn't get better.

The FHB took Epinette back to the vet after 2 weeks of Baytril.  By this time, Ivy the rat was also sick with pneumonia, but the vet said it was a different kind of pneumonia.  Ivy had a different medicine.  Epinette came back with Sulfamethoxazole and trimethoprim.  The FHB put it on Epinette's snow peas and kale.  Epinette did not like it, and she stopped eating the snow peas and kale.  I wanted to eat them, but the FHB said I wasn't allowed.  So, the FHB had to start putting the medicine in a syringe and putting it into Epinette's mouth.  I can tell you, Epinette was not pleased by this turn of events.

By this time, Epinette was having a lot of trouble with her breathing, and she was sneezing and coughing a lot.  She had started to tilt her head upwards, to make it easier for her to breathe, and her nostrils were really flaring.  You can see her head is not in the normal position (like mine) in this picture.

The FHB noticed that Epinette's sides were really moving a lot when she was breathing, whereas my sides were just making small movements, like a normal rabbit.  The FHB gave her the new medicine for a week.

She didn't get better.  She was tipping her head more, and breathing through her mouth.

The FHB shook her head and said this wasn't good, so she took Epinette back to the vet again.

This time, they got serious and did some x-rays.  I bet most of you have not seen an x-ray of a rabbit before.  Here is your chance.  You can see in this x-ray, at the top of the area where her ribs start, there is a sort of a round-ish blob, and on the left side there is a sort of darker triangle-ish area.  That is her good lung.  The one on the other side, the right of the picture, is not dark and open looking, so it's collapsed, and overlaying the heart.  Also, you can see that the whole lung area is kind of speckled or mottled.  That's the pneumonia making fluid or mucus in the lungs.  You can also see that at the base of her ears, she has fairly bright loop structures in her head.  That is the ear infection.  It looks like two letter Vs at the bottom of her head. 

The vet in Moncton sees a lot of rabbits, and she looked at the x-rays and she noticed that Epinette's heart appeared to be extremely large.  I could have said this was because she has a lot of love in her, but the vet said this was because she likely had a heart condition.  The FHB was not pleased with this news because it meant that Epinette had maybe weeks or months to live.  The vet also said this was the reason why there wasn't any yucky stuff coming out of Epinette's nose.  Usually with rabbits, like humans, stuff comes out their nose, and you can see it on their front paws too, where they try to clean their nose.  Epinette had none of that.

The vet said that because it was an unusual case, she was submitting the x-rays to an international panel of consulting vets, to get another opinion.  The FHB liked this idea.

The very next day, a vet in Germany sent information to the vet in Moncton.  The amazing news was that Epinette did not have a heart condition.  What looked like an enlarged heart was actually a normal heart (still full of love) that was overlaid by a collapsed lung.  The lung and the heart together made it look like an enlarged heart.  So, the new diagnosis was that Epinette had pneumonia, and a collapsed lung.  This is quite serious, and in the meantime, Ivy the rat had died of pneumonia, so the FHB was really worried about Epinette.  We still don't know why she doesn't have any stuff coming out of her nose.

The vet in Germany also pointed out that Epinette had a very serious ear infection.  The treatment of rabbit ear infections is quite complicated because in some cases (like Epinette's), the infection is behind the ear drum, so it is hard to access.  The other problem is that the infection is in the ear canal, which is an air-filled space, so the blood vessels carrying any antibiotics do not reach into this space.

So, Epinette got a new medicine that the FHB has to give her using a big scary needle that she pokes into Epinette's back muscle, right next to her spine.  Fortunately, the FHB has had many years of administering sub-cuteaneous and intra-muscular injections to sheep and goats, so she was totally up for the job.  Epinette is less than impressed.

So the FHB gave Epinette an injection, once per week, for 3 weeks, of Duplocillin, which for the scientists out there is a combination of procaine benzylpenicillin and benzathine benzylpenicillin.  It is a strong antibiotic that isn't used in rabbits except in quite serious cases, but Epinette needed the "big guns" for this health problem, so that's what she has.  I am quite worried about her, but Epinette pats me on the head and says she'll be alright.

On Thursday of this past week, Epinette went to the vet for follow-up x-rays to see how things were going.  The FHB felt that her breathing was improving and that she was in less discomfort, although she is still sneezing a lot.  The x-rays showed the good news that Epinette's lung was now re-inflated and not collapsed.  In addition, much of the mottling in the lungs caused by the pneumonia was cleared, but there was still some at the upper portion of the lung, which is why Epinette is still sneezing and having some breathing trouble.  In the x-ray below, you can see that the lung on the right side of the picture is now more open, and there is much less speckling and mottling.  You can also see there is still an issue with her ears.

Epinette is now getting the Duplocillin injections for another 3 weeks.

The not-so-good news was that the antibiotic had essentially no effect on the ear infection.  This is very unfortunate.  At this time, Epinette is not showing any sign of vestibular distress (no head tilt, no excessive ear scratching) so the FHB thinks that she is not experiencing any pain or distress from the ear infection.  However, this could change, and the FHB is going to have to figure out what to do.  The vet said that the pneumonia is the first priority, and we are confident that is getting better and that after another 3 weeks with this antibiotic, she will probably be all better in her lungs.

Here is another picture of the ear infection from March 15...

...and April 5.

Those areas at the base of her ears should not be bright like they are on the x-rays. 

Sometimes dogs have inner ear infections like Epinette's.  Sometimes these dogs have surgery to remove part of the ear canal and they scrape out the infection and pack antibiotic into the space and then sew them up.  This has been done in some rabbits with mixed success.  The FHB will discuss the options with the vet in 3 weeks and will determine the best course of action.  The most important things are Epinette's quality of life and her comfort level.  The FHB does not want her to suffer.

The vet said that Epinette is "sassy" and that she was very grabby with the treats following the x-rays.  This is a positive thing because it shows she is in good spirits and has good energy levels.  I could have told the vet that she is sassy but nobody listens to me except when I am giving audit results.

So, the important thing is that we love Epinette very much and we are doing everything we can to help her get better and we hope that in time, her pneumonia will be all gone and also that her ear infection will subside.  We will keep you posted.