Complication post rabbit enucleation??

RE: Complication post rabbit enucleation??

Arlo Guthrie — Thu, 03 Oct 2019 13:06:04 GMT

With a bit of a heavy heart, because he is otherwise such a gent, I have suspended Anthony Todd's account for the time being, for repeatedly turboposting (despite promising not to!). I mention it in case any regulars wonder where he has gone!

RE: Complication post rabbit enucleation??

Anthony Todd — Thu, 03 Oct 2019 12:20:15 GMT

[quote user="Neil Wheadon"] We know steroids harms people, dogs , cats (less so) so why are rabbits immune?[/quote]

Of course! So does virtually any drug or compound used by any doctor or vet if used incorrectly.

There is hardly any drug that is not toxic if used incorrectly. even water!

Corticosteroids are still, and have been, widely used in all branches of medicine for years, and safely too, and I ask again for the evidence of fatality or harm in rabbits if used correctly and not suspended in alcohol and instill into a poor rabbits eye.

Would put anything off it's food I think!

Surprising, and still, I find the only evidence is the original one then extrapolated to excessive or overdose in all animals so it seems that ALL the opinions trace back to this original paper or diverted to exaggerated use in any species.

Surely someone can see this?

What goes around seems to come around but why are vets so against EBVM if all they have is just an opinion based on very shaky evidence?

Come on guys, this is worth deciding as some rabbits may benefit, as all on owner sites seem to!

RE: Complication post rabbit enucleation??

Neil Wheadon — Thu, 03 Oct 2019 11:51:57 GMT

[quote user="Anthony Todd"]

All the posters on the "lay" rabbit sites must be making their stories up then?

Find me one saying a rabbit died after a steroid jab please, or one blaming steroids for a death.

Oh, any; any; decent evidence, or any at all, that's not an opinion, that shows steroids are deadly for rabbits.

Surely there must be some study somewhere, and more recent, as I said, apart from an opinion.

Why would a scientist make a declaration without some evidence or experience?

Surely it's a good idea to scrutinise some evidence if there are contrary views out there, as steroids can be very valuable sometimes, and probably in rabbits?

I repeat; this is supposed to be the age of EBVM, note the "E"!

[/quote]

The quantity of Evidenced based medicine has increased dramatically in the past 10 years, Much anecdotal evidence hasn't so much been debunked but brought into question. We know more about rabbits than we ever did, but there are few vets out there collating information. It's like canine medicine 20 years ago.

Consider this true anecdote

A dog had diabetes, a locum (it could have been an assistant) spayed it, that brought the diabetes under control. 2 years later the principle vet treated it for superficial pyoderma with a 2 week course of steroids. The diabetes returned. The owner successfully sued the vet for steroid use. It's a warning and that's what VDS cover is for.

Medics are luckier than we are, if you die/have an adverse reaction, they report it and it's centrally collected. Aside referral centres churning out papers (THANKYOU!!) our evidence base is pretty poor in comparison.

The point I'm making is that dogma that something is right and produce the evidence is harming discussion. We have always extrapolated. We know steroids harms people, dogs , cats (less so) so why are rabbits immune?

I'm a totally different vet than 28 years ago, very little that I do is the same as when I qualified. If you read papers from referral practitioners they cite papers from 2013 as a little historic, this profession is moving so fast at times, it's tough to keep up.

Neil

RE: Complication post rabbit enucleation??

Gillian Mostyn — Thu, 03 Oct 2019 11:37:10 GMT

It is pointless Anthony Dennison.

RE: Complication post rabbit enucleation??

Anthony Todd — Thu, 03 Oct 2019 10:20:48 GMT

All the posters on the "lay" rabbit sites must be making their stories up then?

Find me one saying a rabbit died after a steroid jab please, or one blaming steroids for a death.

Oh, any; any; decent evidence, or any at all, that's not an opinion, that shows steroids are deadly for rabbits.

Surely there must be some study somewhere, and more recent, as I said, apart from an opinion.

Why would a scientist make a declaration without some evidence or experience?

Surely it's a good idea to scrutinise some evidence if there are contrary views out there, as steroids can be very valuable sometimes, and probably in rabbits?

I repeat; this is supposed to be the age of EBVM, note the "E"!

RE: Complication post rabbit enucleation??

Anthony Todd — Thu, 03 Oct 2019 10:10:20 GMT

[quote user="Anthony Dennison"]

OK, I'll bite...

[quote user="Anthony Todd"]

The water-loading test in rabbits. A method to detect potential ocular hypotensive drugs.

Tom Mcdonald, John W. Hodges, Albert Borgmann, Floyd E. Leaders
Archives of ophthalmology
1969

[/quote]

[quote user="Anthony Todd"]

Comparative toxicity of two-dexamethasone derivatives following topical ocular instillation to rabbits. II. Systemic histopathological changes.

Albert Borgmann, Donald Bogle, Crawford Robb, Tom Mcdonald
Toxicology
1976

[/quote]

These papers are ancient. Attitudes have changed since then, and thought processes have to. The fact you've had to go back that far to find papers to agree with you just prove how much of a thick-headed dinosaur you are. Marie is an experienced and well qualified exotics vet so knows what she's talking about. You would give a rabbit a jab of steroids and never see it again and count that as a success. Likelihood is that it died and you just weren't aware. Oh no I forgot, your clinical record is exemplary and nothing ever died on your watch

[quote user="Anthony Todd"]

METHODS:

Female rabbits (n=6/group) received dexamethasone phosphate (40 mg/mL ophthalmic solution, EGP-437) transsclerally to the right eye (OD) using the Eyegate(®) II ocular iontophoresis delivery system once biweekly for 24 consecutive weeks at current doses of 10, 14, and 20 mA-min and current levels up to, and including -4 mA for 3.5-5 min

ONCLUSIONS:

The results of this investigation suggest that repeated transscleral iontophoresis with dexamethasone phosphate may be safe for use as a treatment for inflammatory ocular disorders that require prolonged and/or repeated corticosteroid therapy.

From

J Ocul Pharmacol Ther. 2013 Oct;29(8):760-9. doi: 10.1089/jop.2012.0175. Epub 2013 Jul 11.

[/quote]

This was topical eye drops. Not systemic doses of steroids and not at the doses that you like throwing about.

Stop hijacking threads tony, you're not helping anyone and just diluting out the useful information whilst putting people off from contributing.

[/quote]

RE: Complication post rabbit enucleation??

Anthony Dennison — Thu, 03 Oct 2019 09:44:24 GMT

OK, I'll bite...

[quote user="Anthony Todd"]

The water-loading test in rabbits. A method to detect potential ocular hypotensive drugs.

Tom Mcdonald, John W. Hodges, Albert Borgmann, Floyd E. Leaders
Archives of ophthalmology
1969

[/quote]

[quote user="Anthony Todd"]

Comparative toxicity of two-dexamethasone derivatives following topical ocular instillation to rabbits. II. Systemic histopathological changes.

Albert Borgmann, Donald Bogle, Crawford Robb, Tom Mcdonald
Toxicology
1976

[/quote]

[quote user="Anthony Todd"]

METHODS:

ONCLUSIONS:

From

J Ocul Pharmacol Ther. 2013 Oct;29(8):760-9. doi: 10.1089/jop.2012.0175. Epub 2013 Jul 11.

[/quote]

This was topical eye drops. Not systemic doses of steroids and not at the doses that you like throwing about.

Stop hijacking threads tony, you're not helping anyone and just diluting out the useful information whilst putting people off from contributing.

RE: Complication post rabbit enucleation??

Anthony Todd — Sat, 28 Sep 2019 12:43:36 GMT

[quote user="Anthony Todd"]Someone must have something surely or is it just accepted dogma with no evidence at all?[/quote]

And anecdotes on other bunny sites of Csteroid prescription by vets and stated good results??

Found this just now, more recent:

PURPOSE:

To evaluate the toxicokinetics and tolerability (local ocular and general toxicity) of the anti-inflammatory agent, dexamethasone phosphate (a prodrug of dexamethasone) delivered to the eye in rabbits by transscleral iontophoresis.

METHODS:

ONCLUSIONS:

From

J Ocul Pharmacol Ther. 2013 Oct;29(8):760-9. doi: 10.1089/jop.2012.0175. Epub 2013 Jul 11.

Evaluation of ocular and general safety following repeated dosing of dexamethasone phosphate delivered by transscleral iontophoresis in rabbits.

Patane MA1, Schubert W, Sanford T, Gee R, Burgos M, Isom WP, Ruiz-Perez B.

RE: Complication post rabbit enucleation??

Anthony Todd — Thu, 26 Sep 2019 17:42:31 GMT

[quote user="Marie Kubiak"]Because you will cause a likely fatal gut atony with a dose of systemic corticosteroids.[/quote]

I waited, thinking someone would query this, or even provide some evidence, or even possibly research, but nothing!

Judging by the really embarrassing "evidence" I've cited and the [dodgy] published work which doesn't mention the gut at all, I thought surely someone must have the Holy Grail of a little EBVM but no......

Someone must have something surely or is it just accepted dogma with no evidence at all?

RE: Complication post rabbit enucleation??

Julie Innes — Thu, 26 Sep 2019 09:28:54 GMT

the only other thing I was wondering (and again, there are far more expert on here, so please don't shred me!) if the bunny was intubated or you had the mouth open wide for procedures/ rads etc, could it have had some stretching/ inflammation of the TMJ which has left it (hopefully temporarily) having difficulty prehending food?

RE: Complication post rabbit enucleation??

An On MRCVS — Thu, 26 Sep 2019 07:38:20 GMT

Anon here as I‘ve been shot down for comments before and my mental health isn’t up to that right now.

Genuine question Sheryl Calway , if the owners are willing to have CT scan done why not do that first rather than consider removing the lyosypt when it sounds as if the op site looks to have healed fine with no swelling or visible reaction around the orbit. Scan would be less invasiv.

As Marie said it sounds as if there could be something deeper, it’s an odd presentation to be resulting from a bite to the face

It could add more information and rule out other things. If you re operate and the rabbit doesnot improve you then need to do more investigations. Why not start with that as less invasive?

RE: Complication post rabbit enucleation??

Anthony Todd — Thu, 26 Sep 2019 00:13:33 GMT

[quote user="Gillian Mostyn"]I wonder how many rabbits died but their owners didn't post about it on a forum.[/quote]

What a can of worms this thread has opened and Albert Borgmann has a lot to answer for, fortunately not allowed today, I hope.

try these there is more.....

The water-loading test in rabbits. A method to detect potential ocular hypotensive drugs.

Tom Mcdonald, John W. Hodges, Albert Borgmann, Floyd E. Leaders
Archives of ophthalmology
1969

Tap water (100 ml/kg) was administered by oral gavage to normal adult rabbits. Significant elevation of the intraocular pressure (IOP), lasting for at least 30 minutes, was observed. Following… (More)

My bold!! Nothing to do with Csteroids but humane??

Comparative toxicity of two-dexamethasone derivatives following topical ocular instillation to rabbits. II. Systemic histopathological changes.

Albert Borgmann, Donald Bogle, Crawford Robb, Tom Mcdonald
Toxicology
1976

Dexamethasone-21-tertiary butyl acetate (dexamethasone TBA) and dexamethasone alcohol at concentrations of 0.2, 0.1, 0.01, and 0.001% were topically instilled into the right eyes of groups of 10 rabbits for 21 consecutive days. Vehicle control and untreated control groups were used for comparative evaluation. The dose-dependent changes for each compound were (1) lipid and glyocogen infiltration of liver, (2) hydropic changes of liver, (3) vacuolation and multifocal hepatic necrosis of liver, (4) atrophy of Peyer's patches of intestines, (5) white pulp atrophy of the spleen and (6) atrophy of the adrenal cortex. No pathological changes were noted for other tissues including the eye. In conclusion, the results indicate that systemic histopathologic changes for both steroids were comparable and typical for steroids.

Which certainly suggests toxicity, but seems pretty extreme for steroid eye drops and "typical for steroids" seems odd. Does this occur in other animals or humans with steroid eye drops??

This would appear to be where the caveat originated, but curiouser and curiouser I think.

There are more references.

RE: Complication post rabbit enucleation??

Sheryl Calway — Wed, 25 Sep 2019 23:51:27 GMT

Aww, thank you everyone for taking the time to reply. As the OP, it’s been really helpful to have some alternative views...Jill, I hadn’t considered vision in the remaining eye...thank you!.

To update on the patient, there really does not seem to be anything abnormal that could be dental related. Full intra-oral dental exam wnl, I’ve re xrayed skull in case I’d missed something first time around... nothing. Owners would be willing to pay for a CT... but I don’t think treatment options will change.

I’ve been revising my cranial nerves... and have reassured myself that I’m unlikely to have been able to cause any neurological trauma, inadvertently.

The bunny is now presenting as follows... few days after my original post, was able to pick up food (a long stand of parsley) (and was keen to do so)... chewed endlessly on it, but strand of food did not get shorter!! But jaw movements were ok. He has also been using his tongue ok to groom himself and his bunny friend.

As of today, is manipulating small pieces of herbs into mouth and tentatively chewing and now also swallowing... confirming cranial nerves are definitely functional (phew!!).

But there is subtle misalignment of incisors recurring (initially post op this was marked, and corrected during dental UGA at the time I originally posted). He also makes ‘clicks’ and jaw feels clunky...(as if it was dislocated). As he’s improving, I’m wondering whether my lyostypt has been affecting jaw mobility and this is improving as it degrades... or as Rob suggested, we’ve got an inflammatory reaction to its presence...? I’m seeing him again in 2 days... maybe if no further improvement I should remove the lyostypt... but owner so far reluctant as wound has healed so well... would anyone imagine I’d get any issues with haemorrhaging or other swelling if I remove packing at this stage post op...?

i’ve never had any reaction such as this...despite dealing with many abscesses and dental issues...the ‘clicking’ in particular is intriguing me!! Anyways, thanks again to everyone for taking the time to advise me!

sheryl

RE: Complication post rabbit enucleation??

Gillian Mostyn — Wed, 25 Sep 2019 23:24:49 GMT

You're right ... A lot of owners think they helped. Maybe they did, maybe they didn't. And if the rabbit is dying I suppose you can't make things much worse. Not a particularly scientific approach though, don't you think?

I wonder how many rabbits died but their owners didn't post about it on a forum.

RE: Complication post rabbit enucleation??

Anthony Todd — Wed, 25 Sep 2019 23:00:11 GMT

[quote user="Gillian Mostyn"]You might want to scroll down that post a little further to a comprehensive reply by Karen Rosenthal DVM. She's a very eminent vet and she's a better bet wrt advice. [/quote]

You obviously stopped scrolling too soon; keep going to the bottom!!

Much to my surprise, there are more owners writing of dramatic improvements etc.

If a rabbit is really at the end of accepted medicine it would appear that some owners [and some vets] think that C'steroids might help in "last chance" cases, and they did, apparently.....

Not that I knew anything about C 'sroids use [or rabbits, frankly] but, unless these owners are lying, it just might be useful in a "nothing else we can do" or the common "no money for further [expensive] investigation" situation.

To be fair and frank it may be that, as often happens, and on here, opinions and dogma are sometimes based on the sort of discussion seen here and, although I am accused of being a cherry-picker, it seems sometimes others don't even pick up the stones.

Also, and again, as has happened on here, opinions or dogma are based on extreme use [and misuse] of the denigrated drug or procedure.

RE: Complication post rabbit enucleation??

Gillian Mostyn — Wed, 25 Sep 2019 21:29:33 GMT

You might want to scroll down that post a little further to a comprehensive reply by Karen Rosenthal DVM. She's a very eminent vet and she's a better bet wrt advice.

RE: Complication post rabbit enucleation??

Anthony Todd — Wed, 25 Sep 2019 17:59:55 GMT

[quote user="Anthony Todd"]Teach me to check before replying....[/quote]

So I did [still sure I was a *ick and then:

http://forums.rabbitrehome.org.uk/archive/index.php/t-317946.html?s=57a63ad9c655790466ce3a3ee773da91

so not always a disaster and helps a lot sometimes? Therefore if all else fails.....

RE: Complication post rabbit enucleation??

Anthony Todd — Wed, 25 Sep 2019 15:54:07 GMT

[quote user="Marie Kubiak"]Because you will cause a likely fatal gut atony with a dose of systemic corticosteroids.[/quote]

Whoops sorry, and a big touche, obviously didn't know that, retires as best he can.

Teach me to check before replying....

RE: Complication post rabbit enucleation??

Marie Kubiak — Wed, 25 Sep 2019 14:02:45 GMT

[quote user="Anthony Todd"]Why don't you just give a heavy dose of a reasoned antibiotic and steroid? [/quote]

Because you will cause a likely fatal gut atony with a dose of systemic corticosteroids.

To the OP, can you see anything abnormal on the rads at all? I would be suspicious of persisting infection either from a primary dental abscess that burst out at the medial canthus, or as a sequel to the bite. It would be unusual for an external injury to progress to a retrobulbar abscess, especially in such a short time-frame and I would be highly suspicious of a pre-existing osteomyelitis that is progressing.

You may also have a hepatic lipidosis so ongoing aggressive supportive care is essential. If you can scan the liver and compare echogenicity to intra-abdominal fat and spleen to gauge whether it has fat infiltration this may help confirm if this is a confounding factor.

In an ideal world a head CT would give you more detail on co-existing/persisting pathology if there are funds and access. I haven't come across the lyostypt causing issues previously but sounds a possible factor to consider too. I would be using ranitidine at 5mg/kg tid by injection (and add in metronidazole or domperidone orally if no response) as GI stimulant and getting as much syringe feeding in as possible. Where pain management is complicated by response, I have used 2mg/kg ketamine as rescue analgesia in some rabbits as a one off.

Marie

RE: Complication post rabbit enucleation??

Jill Butterworth — Wed, 25 Sep 2019 11:22:54 GMT

Is the rabbit visual in the remaining eye?

RE: Complication post rabbit enucleation??

Julian Earl — Wed, 25 Sep 2019 10:56:52 GMT

[quote user="Anthony Todd"]

[quote user="Julian Earl"]But I suspect the rabbit will not recover from this. Sorry![/quote]

Why don't you just give a heavy dose of a reasoned antibiotic and steroid?

May just be the answer, and even a cure.

Continue if a good response.

After all a diagnosis per se doesn't cure anything, just leads the way to almost certainly the above suggestion.

PS, just reread so try a different AB; maybe the steroid will help anyway.

[/quote]

Why don't I , Antony? I'm confused. It is not my case and if it were I would not check steroids at a bunny with an abscess. Surely that = recipe for further invasion? If teeth, it gives a more accurate prognosis plus treatment options perhaps?

RE: Complication post rabbit enucleation??

Anthony Todd — Wed, 25 Sep 2019 10:08:04 GMT

[quote user="Julian Earl"]But I suspect the rabbit will not recover from this. Sorry![/quote]

Why don't you just give a heavy dose of a reasoned antibiotic and steroid?

May just be the answer, and even a cure.

Continue if a good response.

After all a diagnosis per se doesn't cure anything, just leads the way to almost certainly the above suggestion.

PS, just reread so try a different AB; maybe the steroid will help anyway.

RE: Complication post rabbit enucleation??

Julian Earl — Wed, 25 Sep 2019 09:42:19 GMT

I think that at the top of the list of my concerns would be the abscessation being secondary to molar teeth problems. This would not bode well for further iabscessation so the case should have very guarded prognosis and major warnings to the owner about recurrence etc. Radiography would be advisable before going ahead with any major intervention I think. But I suspect the rabbit will not recover from this. Sorry!

RE: Complication post rabbit enucleation??

Virginia Campbell — Mon, 23 Sep 2019 22:54:37 GMT

Could the stress of illness and surgery have unmasked something else? Struggling to think what though- would expect E.cuniculi to cause hindlimb paresis or head tilt rather than dysphagia.

RE: Complication post rabbit enucleation??

Robert Lowe — Mon, 23 Sep 2019 20:25:45 GMT

Occasionally you can see quite an inflammatory response to retained haemostatic gauzes - might this be an issue?

Rob