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| Pandora's Battle with a Jaw Abscess |
Pandora is a four-year old Holland Lop who has always entertained me with her clownish antics. She loves to buck into the air like a miniature bronco and then tear back and forth repeatedly until she is exhausted. She had never had any health problems, but when we returned home from a three week trip in November 1998, she looked as though she had gained weight. Her face looked fuller but other than that she was eating well and active as always. It wasn't until the following day, when hand feeding her some treats, that I was horrified to feel two large hard swellings on either side of her lower jaw. Each swelling felt like a marble, and I was astonished that such a sinister symptom could have developed so quickly.
Our wonderful rabbit veterinarian, Dr. Gary Schwartz of Wheaton, Maryland, told me that she had two jaw abscesses and that the treatment of choice was surgery to drain the abscesses and debride (scrape away) all the contaminated tissue. He also warned me that abscesses in rabbits can be a nightmare to treat because they are so persistent, and that Pandora's teeth might have to be removed as well. I asked Dr. Schwartz if this surgery was very painful to the rabbit, and also how likely it was to succeed. He replied that rabbits generally tolerated the procedure fairly well and that he would give Pandora an analgesic, but that he couldn't guarantee the results given the typically persistent nature of jaw abscesses. Since this was Pandora's only hope of recovery, I agreed to the surgery and said I hoped he would try to save the teeth.
Dr. Schwartz has since explained to me that there are several conditions which can produce jaw abscesses in rabbits, the most frequent being tooth root infection, and that for some reason rabbits are particularly susceptible to severe jaw abscesses.
Pandora survived her surgery and arrived home looking like Frankenstein with a prescription for oral antibiotics. Unfortunately, as Dr. Schwartz had warned me, the infection had reached bone and was very entrenched. Within a few weeks the swellings were back and Pandora returned to have further surgery including removal of her lower front teeth. By this time I was very concerned that we might be torturing her, but on seeing how quickly she bounced back from the surgery, and how well she adjusted to nibbling food with her lips after her teeth were removed, I concluded that the surgery had been the right choice.
>From that point on I supplied her with plenty of grated carrots and thinly sliced greens, along with parsley, which she found particularly easy to eat. Her appetite remained good, she didn't seem to be in pain, and she tolerated the oral antibiotic therapy well. However, within a few weeks the abscesses were back again.
At this point Dr. Schwartz was away at a conference and I took Pandora to another veterinarian who could offer little in the way of further treatment. She refilled the antibiotic prescription and suggested that I express as much pus as I could from the abscesses, which were draining through the channels left by Pandora's missing lower teeth. I took Pandora home while waiting for Dr. Schwartz to return, and each day attempted to express as much of the pus as possible by gently squeezing the abscesses in a forward direction. Since Pandora has never been a lap rabbit and dislikes being held, this was a struggle and she became increasingly distrustful of me as the days passed. I wondered whether I was doing the right thing and whether I might not be doing her a disservice by keeping her alive, but she was still eating well and not showing obvious signs of pain, so I felt we had some time to decide what to do.
On the day Dr. Schwartz returned, Pandora took a turn for the worse. She became lethargic and stopped eating, and I feared she would not survive much longer. I called Dr. Schwartz, and we discussed a relatively new procedure in which beads which are impregnated with an antibiotic are implanted at the sight of the abscess. Dr. Schwartz informed me that the procedure has been used in human medicine since the early 1970's, but has only been attempted on rabbits within the last few years. The veterinarian combines a bone cement with an antibiotic, fashioning the mixture into beads. The beads are implanted at the site of the abscess and remain inside the rabbit as the antibiotic is slowly released over a period of months or perhaps even years. Dr. Schwartz also explained that in Pandora's case he used an antibiotic called amikacin, and that although this particular antibiotic can cause kidney problems in rabbits if administered via injection, the slow release of the antibiotic from beads does not result in kidney damage.
Having seen how well Pandora tolerated the last two surgeries, I agreed to the bead implants and Dr. Schwartz ordered the bead ingredients to be delivered by FedEx the following day. He also informed me that the beads themselves were relatively expensive which would add to the cost of the surgery, but I felt Pandora deserved this final chance. The following day she had her surgery and the day after that she was home, again looking like Frankenstein but otherwise much improved and eating well. Once more we waited, administered oral antibiotics for ten days, and hoped the beads would kick in. Pandora did well for about a month and then one day my heart sank as I detected a telltale swelling on her lower jaw, but only on one side. We watched it for a couple days and when it was clearly increasing in size, I called Dr. Schwartz again. My thinking was that since the beads seemed to be working on one side, perhaps it was worth another effort to redo the beads on the abscessed side. Dr. Schwartz agreed, ordered more beads, and Pandora was in for her fourth surgery, which consisted of further debridement of the affected tissue and new bead implants, the following day.
Once again, she tolerated the surgery amazingly well and came home perky and with a healthy appetite. This time, however, I was the one who was sick. I had such a bad case of the flu that when it was time for Pandora's stitches to come out, I was too sickto leave the house much less make the two hour trip via subway to Dr. Schwartz's office. Fortunately, he felt that I could remove her stitches myself (I was beginning to feel pretty comfortable handling her for medical care) and Pandora was smart enough to hold still while I worked on her with sharp implements. Pandora again did well for a month or so and then, in a classic example of "deja vu all over again" she developed another abscess on the side of her jaw where the beads had previously worked. I agonized about whether this meant that the bead procedure was doomed to failure, but by this time the surgeries were almost routine, and I took her back to Dr. Schwartz.
When Dr. Schwartz x-rayed Pandora's jaw he found that the infection had not recurred in the area where beads had been implanted, but in adjacent area, so he performed further surgery to debride and place more beads in the infected area. He also decided that there was probably no need for oral antibiotics, so I just took her home (doing well as usual), removed the stitches myself ten days later, and waited to see how she would do. That was in late March, and as I am writing this at the end of August, Pandora has been in apparently perfect health for the past five months.
To my surprise and delight, we are approaching the one year anniversary of the inception of her problem, and but for her missing lower front teeth, she seems as healthy as ever. I've learned to trim her upper teeth with a wire cutter when they get too long, and she's very good about this procedure despite her usual aversion to being held. She's playful and has a hearty appetite. Indeed, one of her typical stunts is to hurl the heavy ceramic food dish in her mouth and hurl it out the front door of her cage when it's empty, to signal that the kitchen staff (that would be me) has been negligent. So it appears that her mouth and jaw are strong and probably not painful. The beads have apparently had no adverse effects, and fingers are crossed that they'll continue to work. The total cost of Pandora's veterinary care has been roughly $1,500 (actually I believe Dr. Schwartz took pity on me and gave me a break on the later surgeries), but she's had nine months of life that have been predominantly happy despite the surgeries. Even if that's all the time she gets, nine months is a long time for an animal with the relatively short life span of a rabbit, and the money and effort seem trivial in relation to the satisfaction of seeing her diving into her plate of veggies, playing, grooming her sister Peanut, and being her usual comical self.
My advice to anyone whose rabbit develops this problem would be to opt for aggressive treatment from the start. If your veterinarian recommends it, I would get the bead implants and if necessary have the teeth removed right away -- the rabbit will do just fine without them. I believe this will give your rabbit the chance of recovery she deserves. I'm very thankful to Dr. Schwartz for the extra time he's given Pandora, and very grateful to still have her in my life. As with any acutely ill companion animal, my interactions with her feel more precious, and each day is a gift to be accepted and savored. This is perhaps the most important lesson we can learn from our rabbit friends.
The author would like to thank Dr. Gary Schwartz of the Wheaton Animal Hospital in Kensington, Maryland, for his technical assistance with this article.
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