Juliet’s nasal infection case history

Permalink: http://rabbitors.info/juliet-nasal-infection-2023

Patient: Juliet (F), a spayed brown Holland Lop. Born in December 2016 and adopted as a rehome in July 2017.

At the start of this saga, she was about 5.5 years old, and 6 years old at formal diagnosis. She had never had any serious health issues before this other than a couple of minor stasis episodes.

She had a period of time when I had her use a water bottle because her messy drinking combined with lack of grooming caused her to lose fur under her chin, but she eventually grew out of it and has been using a gravity water feeder ever since.

She was always housed indoors in an exercise pen or in our bathroom with rugs and fleece blankets. Her diet consisted of unlimited timothy, orchard, and oat hay with small amounts of pellets daily and a variety of vegetables a few times a day.

Initial sneezing observations

6/21/22 (observation):

I noticed she was having sneezing fits for a while - maybe once or twice a day for about half a year. I saw she was having some discharge from the nose and slight paw matting.

We had an annual checkup and vaccination booster appointment scheduled for next week with Dr. S, an experienced and board-certified exotics veterinarian, and planned on possibly asking for an x-ray for her sneezing due to a traumatic experience with a previously owned dwarf rabbit who had chronic snuffles that was ultimately caused by a nasal abscess that wasn’t detected in a radiograph until too late.

6/27/22 (vet):

We got her first Medgene vaccine with Dr. S and also had bloodwork run for her annual checkup. Everything looked fine. Dr. S didn’t seem too concerned about the minor discharge she noticed at the appointment since her lungs sounded fine but prescribed doxycycline for 3 weeks to see if it helped with the sneezing.

Current prescription: doxycycline (antibiotic) twice a day for 21 days.

We finished the doxycycline, but it didn’t really improve the situation noticeably. We tried cleaning her pen some more, but since the cleaning didn’t seem to significantly affect her (for better or for worse), we decided the sneezing wasn’t a big deal, and we’d just continue to monitor at home.

Pro-tip: If your rabbit continues to have significant sneezing fits, please pursue further culture & sensitivity tests and/or radiographs to make sure it’s nothing more serious while your rabbit is still relatively healthy.

Diagnosis

12/20/22 (vet):

I noticed she was huffing and sneezing significantly worse and made an appointment with Dr. S again for 12/22/22 at 10am. I planned to ask for an x-ray for peace of mind.

By 4pm, Juliet was lethargic on the ground and was visibly struggling to breathe. I could hear that she was super congested and ended up rushing her for an emergency appointment with another local vet Dr. C.

Video: Nose flaring and congested breathing before vet appointment

Dr. C helped to clean out some external snot around her nose to help with the breathing, and Juliet visibly gained some more energy after that and was stable enough to not need oxygen for now. Juliet’s lungs sounded fine upon physical examination, and most of the noise was in the throat, not lungs. Dr. C hypothesized possible chronic Pasteurella infection due to the white discharge observed.

Dr. C was not confident about getting head x-rays for Juliet in her current state and didn’t want to sedate her if she was struggling to breathe.

Juliet was prescribed Metacam (meloxicam) and Baytril (enrofloxacin) for now, and I still planned on going to the Thursday checkup with Dr. S to pursue x-rays again since I knew that that clinic could do radiographs without sedation if necessary. Dr. C had also suggested steam therapy, so I went out to buy a small portable unit. Juliet was not a fan, so I gave up with that treatment.

Current prescription: enrofloxacin (antibiotic) and meloxicam (anti-inflammatory) twice a day

Behavior: Juliet started being picky with food, so I gave her unlimited pellets and offered lots of vegetables in the meantime so she’d eat something. Science Selective Adult was her reliable choice, but I tried mixing some Oxbow Adult in as well. Juliet was willing to eat some vegetables, but not much. She stopped eating any hay.

She also stopped eating her cecals, probably because she couldn’t breathe while bending over. Dr. C had cleaned some dried poop off her bum at the appointment, and I saw a decent amount of cecals laying all around her pen for the next few days.

12/22/22 (vet):

I took her to Dr. S for another checkup and to ask for further diagnostics, and Juliet started wheezing extremely hard with nose flaring while Dr. S was trying to examine her. Juliet ended up taken to the back for oxygen support to finish the exam. Dr. S sedated her with midazolam to calm down the rapid breathing and mentioned that it was actually better to sedate rabbits in respiratory distress so they would take deeper breaths. Dr. S also gave her an injection of anti-anxiety medication (butorphanol) and said that Juliet’s lungs sounded clear to her as well, but we’d confirm on x-rays.

We had both body and head x-rays taken of Juliet. It turns out Juliet’s lungs really were fine, but there was visible extreme mineralization in her nasal cavity, likely due to chronic infection.

For comparison, a healthy rabbit would have much more black space in the nose cavity.

Since it was right before the holidays and the office would be closed for the next week, we went home with antibiotics for now, then planned to schedule a CT scan and to consider possible surgery to clean out the pus and mineralization after that. Dr. S didn’t promise that it was a permanent fix because the nasal cavity was already compromised, but since Juliet was already wheezing and flaring her nose so strongly, it was likely needed for quality of life. Rabbits are obligate nasal breathers and cannot breathe through their mouth.

Dr. S prescribed a higher dose of enrofloxacin and added azithromycin, another antibiotic that would also help with inflammation. Juliet’s sedation was reversed before we left the clinic.

Current prescription: meloxicam (anti-inflammatory) twice a day, enrofloxacin (antibiotic) once a day, and azithromycin (antibiotic with anti-inflammatory) once a day for 10 days (until 1/2/23).

Behavior: By the time of appointment, her appetite was probably 70% normal. She had been mostly eating pellets and nibbling at vegetables but hadn’t had any interest in eating her hay yet.

I had to syringe feed her twice after returning home from the veterinary appointment because she didn’t want to eat anything other than a few pieces of vegetables, likely due to the stress and butorphanol given at the veterinarian. However, she started eating pellets again on her own overnight and didn’t need any additional assist feeding after that. She didn’t have an issue eating her cecals anymore, and I stopped finding them on the floor around her pen.

12/24/22 (observation):

Juliet continued to have lots of wheezing sounds, but her behavior was starting to become more normal. I hadn’t heard any sneezing sounds. She finally started eating hay again.

12/31/22 (observation):

Juliet was pretty much back to normal again with behavior and appetite.

1/2/23 (vet):

I stopped by Dr. S to pick up refills of enrofloxacin (antibiotic) and azithromycin (antibiotic with anti-inflammatory) for Juliet. Dr. S asked that I try just enrofloxacin alone for now to see how she did.

While I was there, I scheduled a CT scan with Dr. S for 1/12/23 in anticipation of needing surgery.

Current prescription: meloxicam (anti-inflammatory) twice a day and enrofloxacin (antibiotic) once a day

1/5/23 (observation):

We started azithromycin again for Juliet since her wheezing was so loud and I could hear her squeaking downstairs from upstairs while she ate. I had stopped it on 1/2/23 when the previous bottle expired, and I had to reconstitute a new bottle since each one was only good for 10 days after mixing the powder with water.

Video: Loud wheezing while eating hay (1/6/23), Happily eating meds without force (1/6/23)

Current prescription: meloxicam (anti-inflammatory) twice a day, enrofloxacin (antibiotic) once a day, and azithromycin (antibiotic with anti-inflammatory) once a day

CT scan scheduled

1/12/23 (vet):

I brought her to Dr. S for a CT scan at a local specialty hospital. Drop-off was at 10am, and I picked her up again at 2pm. We scheduled a surgery to clean out all the pus and junk inside her nose for next Thursday pending CT scan results. Other than her whole nose issue, Juliet had healthy teeth and ears.

Current prescription: meloxicam (anti-inflammatory) twice a day, enrofloxacin (antibiotic) once a day, and azithromycin (antibiotic with anti-inflammatory) once a day

Behavior: Juliet snored very loudly but was eating well and behaving relatively normally. I decided to add a humidifier in her area to use at night to see if it would ease her breathing at all.

Videos: Some breathing struggles while eating pellets, Snoring while sleeping

1/13/23 (update):

Dr. S got Juliet’s CT scan report back.

There was lots of fluid and junk in her nose on both sides, but it was noticeably worse on Juliet’s left side. They also found some external fluid in the ears, but Dr. S said it was normal for lop rabbits and only a concern if the fluid were in the middle or inner ears as that would indicate an infection. Her teeth looked good. Everything looked reasonable to proceed with the surgery next week.

1/15/23 (update):

Dr. S had me stop antibiotics for now to get a good culture on Thursday (1/19) for surgery.

Current prescription: meloxicam (anti-inflammatory) twice a day

Surgery and first bacterial culture

1/19/23 (vet):

I dropped Juliet off for surgery at 8am.

Dr. S called around 1pm saying she just finished the rhinotomy/rhinostomy. Dr. S had ended up only operating on the left side since Juliet was already under anesthesia for so long (charged for 48 minutes) and that was the worst side. Lots of pus and some hard rock-like mineralization was cleaned out, and Dr. S sent a piece of dead turbinate for bacterial culture (aerobic & anaerobic).

Dr. S wanted to keep Juliet overnight with oxygen to make sure she was breathing well and wouldn’t have too much inflammation and swelling. I was warned that there was a hole in her head on her nose that we’d need to put antibiotic drops in for at least a month - if everything otherwise went well, the skin would heal over in a month. The bone removed was permanent and would not grow back.

Dr. S called me again before the clinic closed around 6pm to update me that Juliet was breathing well and eating greens.

1/20/23 (vet):

Dr. S called at 8:30am and said Juliet looked stable and was still breathing well and I could pick up after 10am.

I went to go and pick up Juliet around 12pm and was warned by the front desk that she would “look jarring.” Yes, she looked like a zombie bunny.

I could hear a light crackling sound as she breathed. The vet tech assist-fed Juliet right before pick-up just to make sure she had some food in her stomach for now. Juliet was given a long-lasting buprenorphine shot that would last until Sunday.

For at home care, I was told to make sure not to use paper (Carefresh) bedding since it could get stuck to the surgery site - I usually used wood pellet bedding in my litter boxes anyways, which was fine. She was also not supposed to exercise too strenuously for the next 10-14 days.

Video: Crackling breathing

We scheduled a re-check in a week.

Current prescription: meloxicam (anti-inflammatory) twice a day, enrofloxacin (antibiotic) once a day, 3x gentamicin drops in rhinotomy site twice a day.

Behavior: Juliet ate some pellets on her own once we got home and started eating hay by the evening. She didn’t seem to overly care about a giant hole in her face at all.

Video: Eating hay

1/23/23 (observation):

The crackling sounds while breathing stopped. Juliet started eating more and more pellets and vegetables. Appetite wasn’t 100% normal, but it was enough that I didn’t need to worry about assist feeding.

Video: Loud breathing (1/24/23)

1/25/23 (update):

Dr. S told me there was no growth in the culture from last week and said the results likely indicated there was no infection and it was just mechanical obstruction from the dead tissue and mineralized pus that was removed.

Juliet was pretty much back to normal at this point and gobbling down her pellets and vegetables quickly again.

1/26/23 (vet):

This was our first weekly checkup after surgery. I saw a giant 140 lb tortoise as a patient of the other vet Dr. D in the clinic.

Dr. S flushed out a little pus today, but it overall looked good. Juliet won the award for fastest growing hair, likely because the surgery was done in the middle of a molt. Apparently this was not the first rhinotomy for Dr. S, although the last one she did was a year ago.

We discussed the surgery and results further since I hadn’t had a good chance to talk to Dr. S face to face since before the holidays. We would maybe or maybe not need to clean out the other side of Juliet’s nose - it was a moving target. Dr. S had submitted an entire piece of dead bone for culture, so it was highly unlikely culture was completely wrong, especially since the results said that there was no sign of any of the common infectious bacteria you would expect in the nose like E. coli, Pasteurella, Pseudomonas, etc. I also asked about whether we needed to worry about a bone infection since there was one piece left exposed, but Dr. S said I didn’t need to worry and it was highly unlikely.

We planned for weekly flushes by Dr. S for now to make sure too much pus didn’t come back each week.

Video: Loud sniffling (1/28/23)

2/1/23 (observation):

K (my partner) struggled to get the drops in the nose due to fur growth. Juliet didn’t really care about us messing around in it.

Context: I am terrible with dealing with super gross biological stuff (and needles), and my partner K was comfortable with taking care of the rhinotomy site, so K took over that responsibility.

2/2/23 (vet):

The flush looked worse today compared to last week. There was a larger amount of pus, and Dr. S got out a chunk of dead stuff, but it might have been trapped higher in the sinus. We added azithromycin back in to see if it would help decrease the pus development. Dr. S said the bone was looking dry, so we were instructed to put SSD cream on it twice a day. They shaved her nose area again to make treatment easier, so it was a little bloody when I got her back.

2/9/23 (vet):

K said there was a scab covering the hole this time that made it hard to get drops in during AM medication. It was a good thing that Juliet’s flush appointment was in a few hours.

Dr. S flushed out the scab and more pus and said Juliet’s increased sneezing was due to that.

Second bacterial culture

2/16/23 (vet):

The pus flushed out continued to be even worse than the previous week, and we sent out another bacterial culture (aerobic & anaerobic) to see if it would grow anything this time. We still kept to the same medication regimen for the next week.

2/18/23 (observation):

Juliet had a stasis episode that I had to baby her through all night starting at 11pm.

Video: Visible discomfort (2/19/23)

We noticed that she sounded very snotty and might have had some issues breathing. Her temperature was 99.2-99.4F for most of the time. Normal rabbit temperature should be 101-104F, so she was hypothermic.

I sat with her with an electric heat pad, microwave rice packs, and hot plastic water bottles, all bundled in a towel until Juliet finally perked up around 6am after another 20cc of recovery food and started grooming and eating some willow and vegetables on her own. I made an emergency appointment with an exotics emergency vet Dr. L at 9am.

Video: Starting to feel better and grooming herself closer to 6am (2/19/23)

2/19/23 (vet):

At the 9am emergency appointment, Juliet got some fluids, stronger pain medication (buprenorphine), and some cisapride to take home.

Dr. L cleaned out her nose again for us and got out a giant chunk of snot and also physically scraped everything to try and get more infected tissue off to hopefully slow down further pus development. Juliet’s sinus on the upper part around the eye seemed to be clear and nothing came out - it seemed most of the pus generation was in the lower part of her sinus closer to the rhinotomy site.

Dr. L also ran bloodwork for us for peace of mind, and everything looked normal other than WBC count, which was normal for chronic infection and inflammation. Dr. L hypothesized this stasis incident was either from ingesting too much fur since Juliet was still visibly molting or from breathing in too much air when she was struggling to breathe around the snot and got gas in her belly, since Dr. L could feel some gas in there at the exam. Juliet’s temperature was 100.4-100.8F at the appointment, so she was still slowly getting better. We left the hospital around 12pm.

Current prescription: meloxicam (anti-inflammatory) twice a day, enrofloxacin (antibiotic) and azithromycin (antibiotic) once a day, 3x gentamicin drops (antibiotic) in rhinotomy site twice a day, SSD cream (antibiotic) on bone twice a day, cisapride (motility) twice a day as needed until Juliet started pooping well again.

Behavior: Juliet nibbled at some willow and finally started eating veggies after I threatened her behind her back at 4:30pm. Her nose was pretty bloody again after the thorough flushing and cleaning. I ended up only giving her cisapride for two more doses before I wasn’t worried about her pooping and appetite anymore.

2/22/23 (vet):

Juliet’s nose was still bleeding by her weekly flush appointment time, and she would flinch when K put cream on the bone. Her appetite was still improving, and she was better at eating pellets and vegetables again - she was maybe 85% compared to normal. She was still sneezing a little, and her rhinotomy site was scabbing over again.

The culture came back negative yet again other than trace amounts of Aspergillus (a mold) which was probably environmental contamination. Dr. S cleaned out another snot bubble similar to 2/18 and was having us stop all antibiotics (oral and topical) 5 days before (by Friday) the next flush appointment (Wednesday) this time for yet another culture. There was obviously some sort of infection going on since the pus continued to come back, but it was extremely odd that nothing significant was coming back on the bacterial cultures.

We were given some saline to drip in the nose in case Juliet got too snotty in the meantime.

Current prescription: meloxicam (anti-inflammatory) twice a day, enrofloxacin (antibiotic) and azithromycin (antibiotic) once a day, 3x gentamicin drops (antibiotic) in rhinotomy site twice a day, and SSD cream (antibiotic) on bone twice a day until Thursday night; then just meloxicam (anti-inflammatory) twice a day and saline drops as necessary starting Friday (2/24/23) until next flush appointment.

Fungal culture

3/1/23 (vet):

Juliet’s sneezing was not too bad by appointment time, and she mostly had loud breathing like storm winds. Her rhinotomy site was definitely covered in gunk by the time we were leaving the house.

Video: Storm wind breathing

After the flush, Dr. S told me that they got a massive fuzzy chunk of gunk, and the infection was likely fungal instead based on that observation. Fungal (mycotic) infections were apparently extremely rare in rabbits, and the tech said that although they saw it more often in dogs, they hadn’t seen quite a growth like that before either - apparently you could see spores coming off when Juliet was breathing. We sent out for an aerobic bacterial and fungal culture this time (very $$$) and changed up the prescription with an oral antifungal instead and stopped most of the antibiotics.

Current prescription: meloxicam (anti-inflammatory) twice a day, enrofloxacin (antibiotic) once a day, and itraconazole (antifungal) once a day.

Behavior: Juliet really couldn’t care less about her situation and was eating and pooping pretty well still with flops everywhere. She was definitely not a fan of the new antifungal medication even though when I looked it up, it was supposed to taste like cherry-caramel…

3/3/23 (update):

Started using Trimethoprim / Sulfamethoxazole aka TMS (antibiotic) instead of enrofloxacin to use up some old antibiotic refills (with instructions from Dr. S).

Current prescription: meloxicam (anti-inflammatory) twice a day, TMS (antibiotic) twice a day, and itraconazole (antifungal) once a day.

3/7/23 (update):

Dr. S texted me to update that Juliet’s bacterial culture came back with two very resistant strains of Staphylococcus. Both were susceptible to gentamicin and one was susceptible to enrofloxacin. Dr. S wanted to add in daily injections of Penicillin G Procaine aka Pen G for the other strain. There was also growth in the fungal culture, but it was too early to ID it.

Since it was already late in the day and I didn’t want to deal with traffic, I tried to see if I could change Juliet’s flush appointment to tomorrow instead to pick up the new Pen G medication at the same time, but unfortunately Dr. S wouldn’t be in. I just kept my appointment for 3/9 (Thursday) instead, and Dr. S said it was fine to wait until then to pick up the Pen G.

I stopped the TMS (antibiotic) since that wasn’t helpful, and we added back the enrofloxacin (antibiotic) and gentamicin drops (antibiotic) back in our medication routine.

Current prescription: meloxicam (anti-inflammatory) twice a day, enrofloxacin (antibiotic) once a day, itraconazole (antifungal) once a day, and 3x gentamicin drops (antibiotic) in rhinotomy site twice a day.

Behavior: She was still having some long sneezing fits, and K said that it looked like her rhinotomy site was covered in pus and fuzz again. I was too scared to look too closely to differentiate between fur and fuzz growth. K said that he wasn’t able to put any drops in the hole as it was pretty much covered and the drops just rolled off.

Her appetite and behavior had been great in the meantime, and she didn’t sound like she was struggling to breathe. She absolutely hated taking the itraconazole, and I learned to leave it for the last one or she flailed like a maniac and backed up like a dump truck to get away from any subsequent syringe.

3/9/23 (vet):

Vet tech told me they still flushed out pus today, but the tissue underneath looked way better since we started the antifungal last week. I picked up the Pen G to start injections later today and also received some new Mupirocin ointment to put on the exposed bone at her rhinotomy site.

Current prescription: meloxicam (anti-inflammatory) twice a day, enrofloxacin (antibiotic) once a day, itraconazole (antifungal) once a day, Pen G injection (antibiotic) once a day, 3x gentamicin drops (antibiotic) in rhinotomy site twice a day, and Mupirocin ointment (antibiotic) on exposed bone once a day.

Behavior: She seems to be a total champion with the flushes and vet trips and medications. We did our first injection at night, and she immediately gobbled up her reward treat and pellets afterwards. She seemed to care most about the restraint rather than the medicating. 🙂

3/15/23 (update):

Dr. S texted me with an update on the fungal culture. It came back with Bipolaris and Alternaria - neither had any literature documenting infections, but they have been documented in humans, dogs, and cattle. Dr. S was going to work with the lab to figure out what would be the best drugs to use for her.

Behavior: Juliet didn’t have a care in the world and tolerated her daily injections very well. Appetite and behavior were all normal, and while she did have long sneezing fits daily, it didn’t seem to overly affect her breathing.

3/16/23 (vet):

Dr. D took over most of the flush today since Dr. S was still wrapping up a surgery at my appointment time. While they still flushed out pus and mucus, the tissue underneath looked good, and we were to continue the same meds for the next week. Dr. S would update me once they had a chance to discuss the results and possible drug choices with the lab.

3/23/23 (vet):

Dr. S had tried to get the lab in Maine to send the fungal sample to another lab for sensitivity testing, but unfortunately even after repeated calls and emails, the lab threw the sample away. Dr. S said they’d try and see if they could get the lab to redo the culture for free, and if so, we’d stop antibiotics next week in preparation.

Tech mentioned that Juliet was a fantastic fur grower, and she pretty much needed to be shaved every single week during her cleanings. The site was still creating giant mucus bubbles, but the tissue continued to improve with just one minor area that was still showing white. Dr. S and I discussed possibly changing the antifungal medication from itraconazole, and she’d continue to see if she could find more information on the two fungal species found in our culture and what medications would be effective. For now, I’d continue with the same medication protocol since I had just refilled the itraconazole last week. Whoops.

Juliet hadn’t had any digestive issues on the medication so far, and she was breathing pretty well with no loss in weight. All in all, she was in good shape, other than needing to continue to go in for weekly flushes to clear up the mucus as otherwise it would likely cause a blockage on that side of her nose.

Second fungal culture

3/30/23 (vet):

Dr. S looked at what was flushed out today under a microscope and verified that our current medication protocol wasn’t getting rid of the fungal spores. Dr. S called the lab, and they agreed to redoing another culture for free, so I would be stopping antibiotics for her for the next week until her next scheduled flush on Apr 7. In the meantime, Dr. S would check and see what options there were for other antifungal medications for rabbits - the one that was considered didn’t have a long shelf life orally and was not in stock at the clinic, so it would need to be shipped.

Current prescription: meloxicam (anti-inflammatory) twice a day

4/7/23 (vet):

Surprisingly, Dr. S said that the flush looked great this week, and there wasn’t any of the mucus that was flushed out the previous weeks. Since we had already paid for the culture, we sent another sample to the lab for aerobic+fungal culture. We were to continue with the same medication regimen as last week for now, which was only pain medication and no antibiotics, oral or topical, and we would see how it looked next week. Juliet had been quite the mystery for Dr. S!

Current prescription: meloxicam (anti-inflammatory) twice a day

4/11/23 (update):

Dr. S messaged me to tell me that the culture didn't find any bacterial growth. We are still waiting for the fungal results.

4/13/23 (vet):

Dr. S didn't charge me for the flush today since they didn't find anything but a scab. I said that I hadn't heard any sneezing fits lately and that her behavior seemed great and normal. We scheduled our next flush appointment for 2 weeks out instead. They did mention that we could put some cream on the exposed bone if it was looking dry while the skin continued to heal. Fungal results were still in progress.

Current prescription: meloxicam (anti-inflammatory) twice a day, SSD cream on bone as needed

4/19/23 (update):

Dr. S texted me saying that the fungal results re-grew Alternaria, but a new species Conidiobolus was also detected. The lab was going to send the samples to a second lab for sensitivity testing tomorrow or Monday. In the meantime, Dr. S sent in a prescription for voriconazole drops for her nose from an online pharmacy.

Current behavior: Juliet has been doing pretty well on only oral meloxicam for over 2 weeks now. I heard some sneezing fits over the past few days, but nothing as bad as she was at the worst. Crossing fingers we finally have all of this under control.

4/23/23 (observation):

Not sure what happened, but she didn't seem excited about her pellets this afternoon but was willing to eat veggies and treats. She was usually happy about rushing me for pellets at the sound. She did eventually eat them slowly over the next few hours and made a nice pile of poop, so at least she seemed stable enough to skip an emergency appointment since her flush was scheduled for tomorrow.

Current prescription: meloxicam (anti-inflammatory) twice a day

4/24/23 (vet):

Good news, Dr. S said her flush looked very clean again, and we didn't need to come in again unless we visibly saw issues. We could let her rhinotomy site heal over finally. :)

Not so good news - Dr. S couldn't get the new fungal drug she wanted to try compounded by any veterinary pharmacies due to a new FDA law that started getting enforced in the past few weeks. And if we wanted to buy the human version, it would be $300 for a bottle. Since Juliet's nose looked fine and there wasn't any sign of new growth without antibiotics or antifungals for over 3 weeks at this point, we were just going to leave it alone.

Dr. S did note that there did seem to be some damage to Juliet's septum, since the saline flush on her left side started coming out on her right. However, it shouldn't be a big issue, and we could just monitor it.

Current prescription: meloxicam (anti-inflammatory) twice a day

Stable status

5/13/23 (observation):

Her surgery site was nicely covered with new fur growth at this point, so we didn't have to see a hole in her face anymore. :) Behavior and appetite had been great.

Current prescription: meloxicam (anti-inflammatory) twice a day

6/4/23 (observation):

Got around to giving Juliet a good groom due to her unending molting, and her surgery site was even harder to see now.

Current prescription: meloxicam (anti-inflammatory) twice a day

7/12/23 (vet):

Juliet was scheduled for her annual Medgene vax booster, and Dr. S shaved her nose to double check the rhinotomy site. She just had the tiiiniest hole now, and Dr. S said that she would probably have that forever. It was also useful to keep around in case she needed her sinuses flushed in the future if the pus comes back. She hadn't been having sneezing fits much if at all, just molting forever - we were probably on the 3rd or 4th round of molting at this point.

Since her behavior seemed fine and the recovery site seemed to have healed as much as it was able to, Juliet was taken off the meloxicam.

9/5/23 (observation):

Other than yet another round of molting and some scabby fur over her nose, Juliet looked and acted like a normal healthy rabbit. No more ongoing medication was needed since the last vet appointment.

Last updated: 10 Sep 2023
Contact: sneaky.dragon.x@gmail.com