# Bicillin and Zithromax



## 12354somebunny (Jul 7, 2009)

My rabbit Hans has an abscess and I'm trying to treat it with Bicillin + Zithromax. 

It's not easy to find bicillin here but my vet finally managed to get hold of a bottle. It is called Benacillin and it contains 150mg/ml procaine penicillin, 150mg/ml benzathine penicillin and 20mg/ml procaine hydrochloride. I understand that I'm supposed to look for bicillin which contains 150k units procaine and 150k units benzathine. Is 150mg/ml equivalent to 150K units? Is it ok that the mixture contains procaine hydrochloride as well?The vet gave Hans 0.2ml of the drug yesterday. Hans weighs 1kg. 

As for Zithromax, has anybun had side effects from consuming it? The Zithromax I have is a powder, to be mixed with water into a liquid suspension which will contain 200mg/5ml. So Hans should get 1ml zithromax a day. I split the dosage into two i.e. 0.5ml twice a day, about 12 hours apart. Last night Hans got his first 0.5ml dose. Immediately after that he became very subdued, staying hidden in his cardboard box. He refused his favourite treats. He has watery poo.. not bad enough to leave poo puddles on the floor, but enough to cover his bum area in brownish liquid. It was about 4 hours later before he started eating again. When he got his 0.5ml dose this morning, again he became subdued, lost his appetite and had watery poo. I'm very concerned. Should I stop giving him the zithromax and just treat him with the penicillin alone?


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## Maureen Las (Jul 7, 2009)

*somebunny wrote: *


> My rabbit Hans has an abscess and I'm trying to treat it with Bicillin + Zithromax.
> 
> It's not easy to find bicillin here but my vet finally managed to get hold of a bottle. It is called Benacillin and it contains 150mg/ml procaine penicillin, 150mg/ml benzathine penicillin and 20mg/ml procaine hydrochloride. I understand that I'm supposed to look for bicillin which contains 150k units procaine and 150k units benzathine. Is 150mg/ml equivalent to 150K units? Is it ok that the mixture contains procaine hydrochloride as well?The vet gave Hans 0.2ml of the drug yesterday. Hans weighs 1kg.
> 
> As for Zithromax, has anybun had side effects from consuming it? The Zithromax I have is a powder, to be mixed with water into a liquid suspension which will contain 200mg/5ml. So Hans should get 1ml zithromax a day. I split the dosage into two i.e. 0.5ml twice a day, about 12 hours apart. Last night Hans got his first 0.5ml dose. Immediately after that he became very subdued, staying hidden in his cardboard box. He refused his favourite treats. He has watery poo.. not bad enough to leave poo puddles on the floor, but enough to cover his bum area in brownish liquid. It was about 4 hours later before he started eating again. When he got his 0.5ml dose this morning, again he became subdued, lost his appetite and had watery poo. I'm very concerned. Should I stop giving him the zithromax and just treat him with the penicillin alone?



Ido not do not know how procaine hydrochloride will affect the rabbit as you are right that we are giving it in units /ml in the US and that our bicillin has 150unit /ml procaine and 150 units /ml Benzathine penicillin with a total of 300,00 u per ml
Iwill haveto look into the K which could be a unit as I am unsure of it's meaning 

We had problems with zithromax from another forum member almost identical to you although if this drug is tolerated it is a good drug 

medi-rabbit would dose it at 30-50 mg/kg to be given once perday . 
http://rabbitsonline.net/view_topic.php?id=48114&forum_id=16
Iprobably will agree it is the zithromax causing the problem here 

You need to call the vet and talk to him as we are not vets here.

I personally would stop the zithromax and continue the bicillin but this is my personal unprofessional opinion
if you can get a probiotic (beneficial bacteria that is sold for pets) that would be great. you want to find a probiotic that contains the microorganism lactobacillus casei 
In the us it is called benebac and you can also use the type for horses sold as a gel at farm stores ..over here it is called probios.


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## Maureen Las (Jul 7, 2009)

http://www.chrisrichards.com.au/uploads/Benacillin.pdf

Is benacillin refrigerated/

Does it say 150 mg per ml or 150 u per ml


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## Maureen Las (Jul 7, 2009)

http://www.britannica.com/EBchecked/topic/477651/procaine-hydrochlorid

:expressionless


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## 12354somebunny (Jul 7, 2009)

Thanks for your replies, angieluv.

The concentration is stated as mg/ml. I've been trying to google for conversions of mg/ml to unit/ml but haven't had any luck. 

As for the 150k units/ml, I think the K represents a unit of 1,000 i.e. 150K units/ml = 150,000 units/ml.. but I may be wrong, it's just my own guess. The Benacillin is refrigerated. It's a thick, white liquid, which sounds similar to bicillin.

I've also decided to stop giving the Zithromax. I'm afraid I can't check with my vet. We're using this treatment for Hans based on what I've learnt from this forum and from Randy. My vet has not used this protocol before.. but I'm glad she's open to trying it.


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## 12354somebunny (Jul 7, 2009)

I just gave Hans his dose of Benacillin for today, my first time giving a jab.. It looked so much easier when my vet was doing it. First, I had problems tenting the skin, there just doesn't seem to be much skin to tent.. then I accidentally pierced the needle too far out, it went through the other side of the skin and the drug was dripping on Hans' body. 

I tried again at another site, this time I managed to get the needle in properly and was slowly pushing the drug in, but suddenly the plunger on the syringe just wouldn't budge anymore. I removed the syringe from Hans, it seemed as though the needle was blocked. I had to push really hard to get the plunger moving again and the drug shot all over my table.  I hope I get it right the next time


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## Maureen Las (Jul 7, 2009)

I have been trying to find conversions also but am getting lost in them also..


I am having some trouble figuring out why people have been having these issues with zithromax; the type that you used and also that Amy used is the same kind that I used. 

I would send this to Randy in a heartbeat butI know that he is not available now....

You cannot get Convenia can you?
Your vet could write aprescription and you could order on-line from the US. the only thing is that I don't know the rabbit dosage. :expressionless

maybe by the time it came we could get a hold of Randy 

Pm Flashy as she has used Convenia ; she lives in the UK


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## Maureen Las (Jul 7, 2009)

*somebunny wrote: *


> I just gave Hans his dose of Benacillin for today, my first time giving a jab.. It looked so much easier when my vet was doing it. First, I had problems tenting the skin, there just doesn't seem to be much skin to tent.. then I accidentally pierced the needle too far out, it went through the other side of the skin and the drug was dripping on Hans' body.
> 
> I tried again at another site, this time I managed to get the needle in properly and was slowly pushing the drug in, but suddenly the plunger on the syringe just wouldn't budge anymore. I removed the syringe from Hans, it seemed as though the needle was blocked. I had to push really hard to get the plunger moving again and the drug shot all over my table.  I hope I get it right the next time


be sure and wipe the drug off your bun as if he grooms it himself it is the same as is the same as giving it orally


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## Flashy (Jul 7, 2009)

he dosage that my vet used for Convenia was as it was labelled (I believe that's what he said). He said it's given to cats by their weight, and that is what he did for Tilly. We started off giving it every two weeks (which is how it is dosed in cats), but it became clear on day 2 it started to work, on day 9 it stopped working (it was easy to see because we were using it for head tilt so we could see the improvement in her head). We gradually cut down the time in between injections and found that once a week (every seven days) worked eprfectly for her and she was kept on that for 2 months of weekly injections. It changed her life.

However, at the time we did that Randy had only used it for head tilt and had not, at that time, tried it in abscesses I believe, or any other kind of infection. If he has now, I don't know, he may have done, but equally, it may still be an unknown in anything other than head tilt.

The hardest thing with Convenia is that because there is a long time inbetween injections if there are any side effects you have to ride the week out as best you can. The risks seem to mainly be gut issues (cecal dysbosis, chronic diarrhoea, etc) and there is not way to stop it once the drug has bee injected. With Tilly, we saw no side effects at all. We did use Fibreplex during that time until we were sure that she was going to show no side effects. That is basically giving her additional fibre and can potentially be useful in some gut situations but not others (I personally don't think it should be used in a blockage situation, but in this situation I had no issue with it at all and would use it again).

Not sure how helpful that is for you.

I'm sorry you're having a rough time with your buns and hope it improves soon.

x


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## Flashy (Jul 7, 2009)

Oh, I just wanted to say that I wondered if it was hard to tent his skin and inject successfully if he was dehydrated due to the diarrhoea he suffered? Have you tried baby rehydration salts? In the Us it's called pedialyte, and in the UK its called Dioralyte, not sure what you would call it over there.


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## 12354somebunny (Jul 7, 2009)

I've actually emailed Randy, but haven't received a reply from him yet.

I'm not sure if we have Convenia here. It has the same function as Zithromax?

The Zithromax that I managed to get is for children. I'm not sure if that makes any difference? I didn't expect the watery poo.. I only expected some appetite loss. The watery poo really got me worried.

Thanks for the caution, I've wiped him clean 

Now I just need to figure out if I'm giving him the right dose of Benacillin..


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## Flashy (Jul 7, 2009)

Convenia is a cephalosporin (but I have no idea if that's how you spell it), and is another antibiotic. Those that know more could explain the different groups, etc, but there are basically a whide range of antibiotics around that have different uses, or that can be used in replacement of another.


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## 12354somebunny (Jul 7, 2009)

I have previously tried looking for Pedialyte or something similar here but we don't have electrolyte drinks specifically for kids. We have the normal oral rehydration salts for adults, which seem to have quite a high content of sugar.

I'm not sure if tenting was difficult because I wasn't doing it properly or whether its because Hans is dehydrated (that's a good point, didn't occur to me earlier). I'll try to make sure he drinks more. Someone posted on RO ages ago on a homemade pedialyte recipe. I've saved that, and will try it if necessary. Thanks, Tracy!


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## Maureen Las (Jul 7, 2009)

This is how I give bicillin; first of all it has to be diluted as if it is not diluted it will cause sterile abscesses at the site of injection and/ or it is just difficult to push in the thick liquid . Ask your vet for a liter of lacted ringers solution and also a big supply of 23 gauge sterile needles ( any length) and a supply of 25 gauge needlesX 5/8 in. you will also need sterile syringes (3 cc is OK) 

If your vet can show you how to use a butterfly this is what Randy uses; I have not been able to get them for use on rabbits so am more comfortable explaining howI do it. 

Take the bottle of bicillin (or whatever) out of the refrigeratorfor at leasr 1/2 hr before using it. You need to roll the bottle in order to prevent air bubbles from forming in the bottle and also to uniformly mix the drugs which will separate . Mix this drug very well . 

You will also need a bottle of alcohol to wipe off and sterilize the tops of bottles 
Wipe off the top of the bicillin bottle with alcohol . take a sterile syringe and attach a 23 gauge needle . pull the plunger out to the amount that you are going to withdraw from the bicillin bottle .insert the needle into the bicillin bottle and push the air intothe bicillin bottle (to equalize the air pressure in the bottle) and then turn the bottle up and withdraw the amount you want . 

Withdraw thesyringeand replace the 23 gauge needle with a 25 gauge needle which is smaller and then take the bottle of lactated ringers which will have a place to insert a needle, clean the insertion pont with alcohol and withdraw maybe 1 ml of lactated ringers into the syringe with the penicillin . The pencillin will then be thin and milky 
Put the top back on the needle and now you are ready to give it 
I will give you a video on giving subq's 

this is a subqutaneous injection but is the same principle . You should try to rotate places on the body (I think Randy goes up and down the back but not too close to the spine)

When you insert the needle into the rabbit make sure to pull back on the plunger just a little to make sure that you don't get a blood return 
if you get blood return it means that you have hit a vein ; in that case remove the needle and start over. 

I have given a lot of bicillin and there are times I have had to try 3 times to get it in. In those cases i have shot it all over the bun and had to wipe him off. it is not always easy to know that you have an actual tent . The idea is to pull up on the rabbit's skin and pretend that you are putting the needle into the front opening of a tent . it takes some time and practice so don't get frustrated. 
never forget to place the bottle into the fridge as it cannot remain out and remain good ; you can also store the lacted ringers in the fridge as it will be good for a few weeks before you need another liter. if it begins to look cloudy ; get another liter 

Just found a whole article on medirabbit so read and print this out; if it differs from my explanation go with theirs 

http://www.medirabbit.com/EN/Injection/Extracting_medication.pdf

this is on sub q fluids ..still looking for a video 

http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=469

this is a video but i can find a better one (remember this is not an injection but just giving fluids 

[ame=http://www.youtube.com/watch?v=HfH7TPFbk-U]http://www.youtube.com/watch?v=HfH7TPFbk-U[/ame]


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## Maureen Las (Jul 7, 2009)

*somebunny wrote: *


> I have previously tried looking for Pedialyte or something similar here but we don't have electrolyte drinks specifically for kids. We have the normal oral rehydration salts for adults, which seem to have quite a high content of sugar.
> 
> I'm not sure if tenting was difficult because I wasn't doing it properly or whether its because Hans is dehydrated (that's a good point, didn't occur to me earlier). I'll try to make sure he drinks more. Someone posted on RO ages ago on a homemade pedialyte recipe. I've saved that, and will try it if necessary. Thanks, Tracy!



You can use something like gatotade but dilute it and it isn' really that highly recommendedd but better than nothing

and better than the home made concotion unless you are absolutely sure that it is correct...


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## Flashy (Jul 7, 2009)

In terms of the rehydration salts, the Dioralyte that we use over here says 'safe for babies' on it and gives slightyl different instrutions. We have no specific baby one either. If you have one that says safe for babies, that should be safe and ok for bunnies 

Maureen, that's an ace description


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## Maureen Las (Jul 7, 2009)

Thanks Tracy but afterI wrote the whole thing outI found the medirabbit printout !!!

It would be a good idea for this bun to get subqutaneous fluids also as long as the vet is willing to do what you ask....


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## Flashy (Jul 7, 2009)

Isn't that always the way


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## Maureen Las (Jul 7, 2009)

Somebunny I would printout the medi-rabbit article and bring it to your vet who then may feel more comfortable giving you lactated ringers to dilute the bicillin. 

one reason the plunger maystick is that the drug is too thick to go through the lumen of the needle


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## 12354somebunny (Jul 7, 2009)

Maureen & Tracy, 

You've both taken a lot of effort to help me, I'm so grateful for that 

I did print out information on administration of bicillin for my vet to read. She gave me a bottle of sodium chloride to mix the drug with. I draw the bicillin into the syringe first, then draw in an equal amount of sodium chloride to dilute it. You're probably right, angieluv, about the needle possibly being blocked by the thick drug. I will dilute it further when I do the next injection.

Thanks for your explanation and the medirabbit article. It's really helpful. I didn't know I wasn't supposed to shake the bottle. That's what the vet did yesterday yikes!


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## Maureen Las (Jul 7, 2009)

*somebunny wrote: *


> Maureen & Tracy,
> 
> You've both taken a lot of effort to help me, I'm so grateful for that
> 
> ...




Actually sometimesI shake it (guilty)and then let it sit awhile because the rolling is so hard to keep doing 

but technically it should be rolled.


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## Maureen Las (Jul 8, 2009)

Any news on this bunny? :expressionless


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## JadeIcing (Jul 8, 2009)

Ringo takes Zithromax and has done just fine. He has taken it about two years now on and off. He has never had an adverse effect from it. 

I also did a LOT of research with about it. I was the one who chose it for Ringo.


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## Maureen Las (Jul 8, 2009)

I know Ali that recently a few buns have had issues with it ??? I know that Randy has used it all the time.........:expressionless


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## JadeIcing (Jul 8, 2009)

*angieluv wrote: *


> I know Ali that recently a few buns have had issues with it ??? I know that Randy has used it all the time.........:expressionless


Thanks to Ringos amazing progress with it the rescue uses it and it has helped several rabbits. I am seeing one but not sure that it is the zithromax.


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## JadeIcing (Jul 8, 2009)

I forget butConnor also used it and thanks to it recovered and has never been ill again. He was on meds for 7mnths straight before it.


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## 12354somebunny (Jul 9, 2009)

Angieluv, I've stopped the Zithromax and the lethargy, appetite loss and watery stool have all stopped.

Right now, Hans is only getting the Benacillin. 3 daily doses the first 3 days, then every other day. He's getting 0.2ml of the Benacillin, until I hear from Randy or anyone else who knows the proper dose based on the 150mg/ml concentration of procaine & 150 mg/ml benzathine. 

I'm a little worried that if the dose is incorrect e.g. too low, it may cause the bacteria to become resistant. The vet prescribed 0.2ml based on the dosage of 35,000 - 40,000 units/kg (this dosage is for bicillin with 150k unit procaine & 150k unit benzathine - the vet assumed that 150mg/ml is the same as 150units/ml but I still can't find anything that supports this  )


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## 12354somebunny (Jul 9, 2009)

When I gave Hans his injection last night, the injection site was slightly swollen because of the drug beneath the skin. The swelling went down after just a few minutes. Is that ok? There was no swelling when the vet gave Hans his first injection.


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## Maureen Las (Jul 9, 2009)

I deleted an entire long post becauseI read the original post wrong so if anyone read it please dismiss it. 

The dosage is correct assuming we are dealing with the correct amount for" K" which is also unknown to me. 

It is not normal to have swelling under the skin but it could be due to the procaine hydrochloride in the drug of which I have no knowledge. 

I want to stress that I do not have Randy's massive knowledge base and have learned most about rabbit's through this site, etherbun and also Randy. I am also feeling my way along with this.

I have been wracking my brain trying to figure out why there have been so many rabbits that have been unable to tolerate zithromax recently. I am wondering if it is the preparation . In the childrens version the powder which is mixed with water is heavily laced with sugar and syrup so a child will take it ; I am wondering if this is what is affecting the rabbit?I had to give this type also , gave too low a dose and still myrabbit lost some of her appetite and did lose a little weight. Zithromax is usually anexcellent drug for this problem and it is shame that we cannot use it here.


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## tonyshuman (Jul 9, 2009)

I am guessing that 150K=150units/mL=150mg/mL

Bicillin and Benacillin seem to only be sold at that concentration.

The procaine hydrochloride I have only heard of as a topical anesthetic, but wikipedia says it's commonly used to reduce the pain associated with a penicillin injection. http://en.wikipedia.org/wiki/Procaine

I am guessing that the swelling was due to slow absorption of the drug--it may have made a pocket in the subcutaneous layer if it wasn't injected properly. I am assuming you're doing sub-q injections? It's possible it got in the wrong layer, such as between the fat and skin. I don't have any practical experience giving injections, so I don't know.

This site is a good study of bicillin: http://www-unix.oit.umass.edu/~jwmoore/bicillin/bicillin.htm

I wouldn't worry from that site that Hans isn't getting enough--they give a dose of 75,000 units/day, which would be 0.25mL of your stuff. 0.3mL might actually be too much. The dose seems to be determined by adding the two drugs' concentrations, ie 150,000units penicillin procaine and 150,000units penicillin benzathine=total concentration is 300,000 units.

Saline dilution will help with pain as well.


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## Maureen Las (Jul 9, 2009)

*tonyshuman wrote: *


> I am guessing that 150K=150units/mL=150mg/mL
> 
> Bicillin and Benacillin seem to only be sold at that concentration.
> 
> ...


Thank you Claire


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## Maureen Las (Jul 9, 2009)

I was thinking that the head of our forum ( Pipp)who lives in Canada has successfully used the combination of chloramphenical (sold as Chlor-palm) in Canada and benzathine pencicillin(they don't sell bicillin there ) for abscesses. 



Chloramphenical has been banned for human use in the US due to it's ability (in a small % of people to destroy bone marrow simply from skin contact with the drug. ). Rabbit owners who use this drug simply wear gloves when administering it. I have used a weak form as an eye antibiotic for my rabbit very successfully. it is a powerful drug that is one of a few that has the ability to pass the blood-brain barrier thus very powerful in getting into the core of an abscess and destroying bacteria .
I have never used chloramphenical as an antibiotic orally for a rabbit because many vets are not willing to deal with the possibility of the human owner being affected by the drug . 

I would pm Pipp and ask her about her experiences because it may be that your current vet would be willing to try this drug for your rabbit in addition to the penicillins

http://www.medirabbit.com/Safe_medication/Antibiotics/Safe_antibiotics.htm

I just noted that this drug also leads to loss of appetite which would make me more interested in learning if Pipp ever had problems with it. 

Thisjust occured to me today as i was thinking about your situation. 
I also would be more interested in more details re. the abscess on your bun...ex location , size , etc. 

Maureen


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## 12354somebunny (Jul 9, 2009)

Tonyshuman, I was afraid that the swelling meant that I had injected in the wrong layer  I hope I get it right soon, it's really hard to tell which layer I've put the needle in. I don't dare to poke too deep, in case I hit muscle/flesh. 

Angieluv, is it a must for bicillin to be complemented by another drug in order for it to successfully eradicate the abscess?

About the abscess, it's located on Hans' right lower jaw. Hans used to have malocclusion. His teeth were also growing in odd directions e.g. on his lower jaw, the left incisor grew to the right and it blocked the right incisor's growth path. So the right incisor was kind of 'stunted'. I suspect that the abscess could be due to the right incisor's stunted growth, resulting from irritation of the incisor root. But that is just my guess. I've discussed it with Randy before and he mentioned there could be other causes of the abscess although its difficult to determine what the exact cause is.

Hans had his incisors removed in April. At that time, the abscess was already there. After incisor removal, Hans was on oral Baytril for about 3 weeks. I wanted to use bicillin then, but the vet was reluctant to try it and thought that Baytril will do the job.

The abscess went away, but returned a few weeks later.. which brings us to today and our current treatment with Benacillin.


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## Maureen Las (Jul 9, 2009)

I would feel that you could try benacillin alone and see if the abscess clears up and. ..as long as the incisors were removed then the source of the infection would begone 

how is your rabbit?. How does the abscess seem after just a few days of the benacillin. My experience with the bicillin alone is that for some infections it does the trick but for some other more difficult infections it is not enough. 
You could always add a 2nd drug at a later date . i would make sure that your rabbit was kept on the drug for a lengthy period (6 weeks) and if there is any change for the worse and not for the better then a 2nd drug would be tried to complement the bicillin.


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## Maureen Las (Jul 9, 2009)

When I give sub q injections I pull up a lot on the skin ( sort of like pulling the top sheet up on a bed ) ; my rabbit puts up with a lot as his skin is loose and it is very difficult to find the "mouth" of a tent and successfully place the needle inhorzontally with the bevel of the needle upwardwithout it poking out the other end and shooting all over him. 
i will try to find the other video as there is a better one than I posted originally. It really takes experience and patience to get this right and you will get the experience 

Just think of a raw piece of chicken ..you want to get the needle between the skin and the muscle. 
I cannot find anything on an injection alone but this sub q video is better than the other one 

[ame=http://www.youtube.com/watch?v=Wdf-M9miFzE]http://www.youtube.com/watch?v=Wdf-M9miFzE[/ame]


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## tonyshuman (Jul 10, 2009)

The benacillin alone may do the trick. Especially since Hans had such difficulty with Zithromax, it would be best to try just the one drug for a while. If there is no improvement in a few weeks, you may need to do the double treatment.


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## 12354somebunny (Jul 10, 2009)

So far, Hans has only received 3 shots of benacillin. The first shot was done by the vet, the second and third shots were done by me and since I had some problems with doing it properly, maybe he got a little less than the dose he's supposed to get. I haven't noticed any changes yet. The size of the abscess appears to be the same (but at least it didn't get bigger). The good thing is that the benacillin has zero effects on Hans' appetite/poop/behaviour. He is as normal as always.


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## 12354somebunny (Jul 10, 2009)

*angieluv wrote: *


> When I give sub q injections I pull up a lot on the skin ( sort of like pulling the top sheet up on a bed ) ; my rabbit puts up with a lot as his skin is loose and it is very difficult to find the "mouth" of a tent and successfully place the needle inhorzontally with the bevel of the needle upwardwithout it poking out the other end and shooting all over him.
> i will try to find the other video as there is a better one than I posted originally. It really takes experience and patience to get this right and you will get the experience
> 
> Just think of a raw piece of chicken ..you want to get the needle between the skin and the muscle.
> ...


Argh, I can't watch it now as youtube has been blocked by my office. And the internet at home is down at the moment.

I think I understand from your description. Tent the skin, then inject from the 'entrance' of the tent, right?

Hans doesn't have much skin, lol. Each time I try, I can only make a tiny little tent. I hope that when I push the needle it, it actually goes between the skin and the muscle. Will I know if I hit the muscle/flesh? Will there be more resistance? I don't want to inject him at the wrong site.


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## tonyshuman (Jul 10, 2009)

That is good that his appetite and behavior are normal. I think watching the video if at all possible will help a lot. It can be really painful to get penicillin in the muscle. I don't have any experience giving injections, so I'm sorry I can't help with that.


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## Maureen Las (Jul 10, 2009)

*somebunny wrote: *


> *angieluv wrote: *
> 
> 
> > When I give sub q injections I pull up a lot on the skin ( sort of like pulling the top sheet up on a bed ) ; my rabbit puts up with a lot as his skin is loose and it is very difficult to find the "mouth" of a tent and successfully place the needle inhorzontally with the bevel of the needle upwardwithout it poking out the other end and shooting all over him.
> ...



Sometimes you can get resistance because you are in the dermal layer rather than underneath it. Pull up the skin imagining that you have a pup tent..I tend to try to pull it up high to see where I'm at; but my bun is older and likeI said he has loose skin and puts up with it .......then just insert the needle with bevel upwards into the" front of tent" so to say . Sometimes if there is resistance you can pull the skin up a little higher . if you were in a muscle your bun would jump...

Also can you read the label off the needle ? What size you are using ? Could be too long or thick which would make this very hard

you want to make sure that you are not in a vein so pull back on the plunger to make sure there is no blood return 
How is he doing/?
I saw Christine's response on etherbun; Randy hates baytril and would not want to combine that with anything... but if you wanted to reply to Christine you could ask her if her bunny's abscess disappeared from that treatment. 
In other words you want to get rid of the abscess bottom line


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## 12354somebunny (Jul 11, 2009)

I may have been in the dermal layer previously. Last night when I gave another injection to Hans, again I felt some resistance. I pushed the needle in just a little bit more and the meds went in very easily after that! I think I did fairly well with the injection last night  

I did reply to christine, but I don't see my reply in the main page. I don't know if the reply went to christine only, instead of the rest of the group.. 

At this point, I'm not too keen on baytril either. After Hans' incisor extraction, he was on baytril for about 3 weeks and the abscess went away. However, the abscess returned a few weeks after that. Because my vet wasn't sure how quickly she could get bicillin, she put Hans on Baytril while she searched for bicillin, to prevent the abscess from getting worse. Baytril didn't work this time, Hans' abscess got bigger. I don't think baytril will help much this time round.


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## Maureen Las (Jul 11, 2009)

Congrats on getting the injection correctly 

Christine would have just got the reply personally. I have not heard much of a baytril/bicillin combination on this website but I have heard of people on etherbun using it. The idea of 2 drugs is the synergistic effect of the 2 drugs working together

Did you think about pming pipp re, the Chlorpalm? I know that some people are veryuncomfortable using that drug ( i was one of them) but i would use it now if given the opportunity and had a bun with an abscess.. 
there is the possibility of an appetite reduction but she would know about that in terms of her own rabbits.


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## 12354somebunny (Jul 12, 2009)

Hi Maureen,

Chlorpalm would be chloramphenicol?

I normally copy and save information from the Infirmary thread on my computer, so that I'll have quick access to it whenever necessary. I went through my notes for abscesses, and in there, it is said that 'chloramphenicol should not be used if penicillin is used'. Now, I can't remember who said that.. I'll pm Pipp to find out more about her treatment protocol with chlorpalm.


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## tonyshuman (Jul 13, 2009)

Yes chlorpalm is the brand name for chloramphenicol.


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## Maureen Las (Jul 14, 2009)

Streisand
Did you get in touch with Randy? :expressionless

You're right that technically Chloramphenical and bicillin is not recommended to be used together
Ibelieve that it isn't so much that it is 'dangerous" as that one drug inhibits the full action of the other.
I still know that Pipp has successfully treated abscesses with this combo 
How is Hans?

Maureen


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## 12354somebunny (Jul 14, 2009)

Hi Maureen,

Thanks for asking  I haven't heard from Randy yet, but I did hear from Pipp about using chlor palm + bicillin. I think for the time being, I'll stick to using only Benacillin. Hans started getting Benacillin last Monday, so it has only been a week of treatment. I'm keeping an eye on the abscess to see if it gets any smaller - at the moment, it hasn't increased in size but isn't significantly smaller either. 

Hans is fine, otherwise. He's having his salad dinner now as I type  I'll be giving him another injection after this.

Here's a photo of him taken last week, after my first attempt at giving him his jab:


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## Maureen Las (Jul 14, 2009)

Hi Streisand 

Hans is really a cutie !! darling!

I know from experience (and a few friends here ) that using the biillin can hold a bad infection at bay for a long long time meaning that it won't actually totally resolve it but it won't get worse either. 


You can dowhat yourdoing and hopefully it will resolve.......... but at some point you may need another drug with it to actually get rid of it....

anyway I'm glad that he's doing OK now 

keep us posted 

Maureen


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## 12354somebunny (Jul 14, 2009)

That's my concern actually, since I'm still not certain whether I'm giving him the right dose. I haven't managed to figure out the conversion from mg/ml to units/ml  I'm afraid that what Hans is getting is only a 'maintenance' dose.

I asked my vet again about the concentration of procaine and benzathine in Benacillin, and she thinks 150mg/ml is equivalent to 150K units/ml but I can't seem to find anything to support this on the internet 

It's not that I don't trust my vet.. I'm really grateful that she helped me find the bicillin, taught me how to administer it etc. It's just that this is the first time she's tried bicillin on rabbits, and she calculated the dosage based on Randy's advice to me on the assumption that mg/ml = unit/ml. And if that assumption is incorrect, then the treatment might not effectively deal with the problem  

Sorry for ranting. I shall try harder to find out whether Hans is getting the right dose. I sent an email to Marcy Moore (author of this article: http://www-unix.oit.umass.edu/~jwmoore/bicillin/bicillin.htm), to see if she has any advice for me. Still waiting for her reply.. In case studies attached to the article, the rabbits were abscess-free after being treated with bicillin only. So perhaps there is hope for Hans with Benacillin, at the right dosage.

I'm open to the idea of combining Benacillin with another antibiotic but since there seems to be conflicting thoughts about chloramphenicol (whether or not chloramphenicol should be given together with bicillin), I'm not sure at this point whether to introduce chloramphenicol to Hans.. 

My vet doesn't think its necessary to use another antibiotic, in fact she didn't think I needed to try Zithromax to begin with. So I guess her answer as to whether I should use chloramphenicol will be similar i.e. not necessary.


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## tonyshuman (Jul 14, 2009)

He is such a doll. I too wish I knew the conversion from units to mg. Perhaps after 2 weeks of Benacillin, you can reassess the treatment to see if it is working, and add another drug if needed. I would have liked to see at least toms improvement in the first week, though.


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## 12354somebunny (Jul 14, 2009)

OK I just heard from Marcy. She says Benacillin's composition is very much similar to the US bicillin versions, the ones with 300K units/ml in total. And that she has had success using only bicillin alone.

tonyshuman, I was hoping to see improvements quickly too. I hope there'll be significant improvements by this weekend!


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## Maureen Las (Jul 15, 2009)

*somebunny wrote: *


> OK I just heard from Marcy. She says Benacillin's composition is very much similar to the US bicillin versions, the ones with 300K units/ml in total. And that she has had success using only bicillin alone.
> 
> tonyshuman, I was hoping to see improvements quickly too. I hope there'll be significant improvements by this weekend!



Wow !

You're a go-getter to go right to the author of that famous article and e-mail her 

:blueribbon:in getting help for your bunny !!!

Congratson getting the info 'straight from the horses mouth" as we say over here. 

Maureen


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## 12354somebunny (Jul 15, 2009)

The things we do for our buns!! :biggrin2: :biggrin2:


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## 12354somebunny (Jul 15, 2009)

I've just found a couple of write-ups where it says that 1mg = 1,000 IU. This is in respect of procaine penicillin. First paragraph, second page of this article: http://journals.cambridge.org/downl...78a.pdf&code=2c5b4261d5c4af2bdb323feb4fadd1e3 and also here: http://www3.interscience.wiley.com/journal/120798330/abstract?CRETRY=1&SRETRY=0

Still haven't found anything for benzathine penicillin but I suppose the conversion should be the same as for procaine..


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## tonyshuman (Jul 15, 2009)

I agree that he conversion should be the same. The long form of the names are procaine benzylpenicillin and benzathine benzylpenicillin, so they both are converted in the body to benzylpenicillin, aka penicillin G. Benzathine benzylpenicillin differs from procaine benzylpenicillin in that it is a longer-acting form of the drug, as it hydrolyzes to penicillin G more slowly.

all of this from wikipedia


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## 12354somebunny (Jul 22, 2009)

Hans just passed away. I feel like crap 

I was giving him his injection. 5 seconds after I was done, he went limp, gave a few soft breaths, shuddered and left us.

I can't figure out what happened. The injection went as usual, he didn't flinch or anything. What went wrong???????

I can't express how horrible I feel right now. I can't write anymore

Goodbye Hans. I love you so much and always will.


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## Maureen Las (Jul 22, 2009)

OMG :shock:
I am probably as upset as you are.;
I am so very sorry ; very very sorry
When you feel better can you give any more details re his behavior recently ; was he improving ?


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## tonyshuman (Jul 22, 2009)

How shocking! I'm so sorry. I am sure this wasn't due to anything you did. Was he pooping and eating normally? Acting normal otherwise? I really thought that he was on the right treatment and would be better soon. How terrible.


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## Flashy (Jul 22, 2009)

I'm so sorry Streisand. I'm just really, very sorry.

Binky Free Hans.


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## JadeIcing (Jul 22, 2009)

You did everything you could and even more. You were the best thing that could have happened to Hans.


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## 12354somebunny (Jul 22, 2009)

He was getting better. the abscess was getting smaller. it's my fault, i must have done something wrong with the injection. he didn't flinch so i don't think i hit his muscle/flesh. but dammit what if i hit a blood vessel?!!!! i feel so horrible


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## Maureen Las (Jul 23, 2009)

Streisand
,
If you pulled the skin up and inserted horizontally you shouldn't have hit a blood vessel ; if you think that you were in muscle then it is possible. 
You cannot blame yourself for this. 

I am giving one of my rabbits injections right now andI don't always pull back on the syringe before I inject because I am sure I am above the muscle ..but I sometimes I don't do it because I give these injections without help from anyone and I do the best I can ; he is hard to hold 

Today I attempted to clip my dentally challenged rabbits teeth in front because I cannot do the 3 hr drive to the dentist vet every month. 

Iclipped one tooth and broke another . I made a mess of it .

Why? 

because the same as you I am trying to be a vet when I am not a vet ....
I feel terrible about Hans because you obviously went above and beyond to help him ; I admire yougreatly for contacting Marcy re. the benacillin !
I am so sorry that you lost him ; it isn't right because you tried so hard But you are a truly outstanding rabbit owner 
You tried to help him from deep down inside yourself and did the very best that you could ..
Without a necropsy you can never know for sure ; so often we are so sure that we caused damage when it was another unseen problem; 

it has occurred time and time again ..owners blaming themselves for something being wrong when the bun may have had a hidden cancer. . 

I know you are heartbroken because Hans is gone and nothing now will take away the pain of that but please give yourself the credit of being a really great rabbit owner . 
Hugs from the heart 

Maureen


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## 12354somebunny (Jul 23, 2009)

Thank you so much for your kind words Maureen.

I'm quite sure the needle was just under the skin, but the fact that I didn't pull back on the syringe this time just makes it so difficult. I keep going over everything, trying to figure out what happened. I know I should try not to dwell on it, but I can't. I keep thinking, what if I had just spend an extra few seconds to pull back the syringe, maybe he'll still be here with me 

I barely slept last night. I'm at work today and struggling so hard to hold the tears back.

Sorry to hear about your bunny's broken tooth. Give him/her an extra hug from


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## Flashy (Jul 23, 2009)

I completely agree that this was not your fault and you should not be blaming yourself, but I also know that is easier said than done.

It is much easier to blame ourselves than to realise that we had no control over a situation because if its our fault then maybe the bunny might still have been here. If we allow ourselves to accept that it was not our fault then its like accepting that the rabbit is gone or that s/he was meant to die or something.

Whilst you know what you were seeing with Hans in terms of the abscess improving but its completely an unknown as to what was going on inside him and things could have been more severe and complex than any of us could ever have dreamed.

You absolutely gave Hans the best shot. you were in a very difficult position and yet you went above and beyond what any owner can be expected to do. He was so so lucky to have been loved by you and, as sad as it sounds, he was lucky to die with you, and not alone.

It is hard to grieve and if you need to cry then try to allow yourself when it permits (I understand that obviously work is not always the easiest/best place to cry).

Please keep talking to us if it helps. 

Also, I know we haven't spoken for ages but we did used to talk a lot in chat and if you do ever want a chat, feel free to PM me or add me to msn. [email protected]

x


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## Maureen Las (Jul 23, 2009)

*somebunny wrote: *


> Thank you so much for your kind words Maureen.
> 
> I'm quite sure the needle was just under the skin, but the fact that I didn't pull back on the syringe this time just makes it so difficult. I keep going over everything, trying to figure out what happened. I know I should try not to dwell on it, but I can't. I keep thinking, what if I had just spend an extra few seconds to pull back the syringe, maybe he'll still be here with me
> 
> ...


Would you ever be able to get a necropsy done on him? ( I'm sorry to be asking you this ) 
if you did it could possibly help your friend feel better re. giving benacillin to her rabbit and also ease your own mind if there wassome other problems with him...
if you don't want to respond to thisI will totally understand . you are in terrible grief and I am trying to figure out what happened....


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## tonyshuman (Jul 23, 2009)

It was not your fault. Anything you did was to help him feel better, and it was helping. We're going to try to figure out what happened by looking into these drugs and discussing how they could have affected him. We're discussing it in The Fluffies' thread.

I am proud that you fought to hard to get Hans the right treatment. It takes a lot of courage to stand up to a vet and tell them what you think is right, to do research on your own, and to challenge them. We so often see vets as people who have already learned everything and our opinions don't matter in comparison to them. This is not true--they need to be lifelong learners just like everyone, and pushing your vet to learn more about this was difficult and took some real strength. You did right by Hans in trying to get him the best care possible. Something went wrong, but it was not your fault. Like angieluv said, even if it was a mistake in the injection, you didn't do it on purpose--you were trying to help him. You also haven't been trained to do this for your career, like a vet would (just like angieluv and the teeth). When we try to do something to help our rabbits and do the best we can, it's not our fault if it doesn't go right. Just like in every part of life--if you try your best and don't get the outcome you want, you still did your best and are not to blame for the outcome.

Sorry if that got a little weird and psychological but it's true. I wish I had the strength to tell a vet what treatment I wanted for my guys. I haven't had to do that yet, but I think if a vet doesn't do what I want, I'll just find a vet that will because I live in an area with a lot of vets and a lot of good vets, so that if I want to do something that makes sense medically I'll be able to find a vet that agrees with me. You don't have that option, so you have to be strong and assertive and tell the vet what you want, even if it's difficult.


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## Maureen Las (Jul 23, 2009)

We have been talking about this on Fluffies thread
if it had been injected into the vein it would have been a violent reaction, maybe seizures 
You didn't inject into the vein; it's possible that he died from stress


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## Maureen Las (Jul 23, 2009)

I apologize for not respecting your grief re. this and analyzing it 

Sorry Strriesand 
Hugs 
Maureen


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## 12354somebunny (Jul 23, 2009)

No apologies needed, Maureen.

I think of Hans all the time, and that fateful night. Memories of him still bring tears to my eyes, but I know that someday I'll be able to think of him and smile instead of cry. Like you, I'm also analyzing the cause of his departure. I hate not knowing why. I'm afraid I can't get a necropsy, I don't even know if its possible to do so here. We buried Hans the same night he went to the bridge. We live in an apartment but luckily I have a good friend living just across the road from us and Hans is resting in a little grassy piece of land next to her house.

There weren't any violent seizures. I'll try to recap everything since it's still fresh in memory: When it was time for the injection, my husband went to carry Hans out from his playpen and onto a table. At that point, he mentioned that it was a breeze grabbing Hans that night (usually Hans will run away and my husband will have to chase him around the playpen). But he seemed alright when we put him on the table, he moved around a little but husband kept him still so that I could inject. After the injection, Hans moved to get away from my husband's grip but I told my husband to pet him and keep him still because I wanted to take a picture to show that his abscess was shrinking. I also turned around to pet Hans and it was then that he went quiet. He was crouched down with his head down & close to the table, slightly tilted to the right.

We were shocked and kept stroking him. I tried calling my vet on her mobile but she didn't pick up. His head tilted a bit more to the right, then he kind of flopped down on his side. At this point, he was giving out faint breathes, about 3 times. The whole time we kept stroking him. Then I felt a final slight shudder run through his body and I knew he had left us. It happened very quickly, but it wasn't violent in any way.

Flashy, I remember our chats. You were the first person I talked to in RO and I remember your beautiful tribute to Flash. I'll add you on msn one of these days, for now I'm staying away from msn as its too painful to keep repeating what happened to each person who asks. I know they ask because they care and I appreciate it, but its just too hard right now.


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## Hazel-Mom (Jul 23, 2009)

*tonyshuman wrote: *


> I am guessing that 150K=150units/mL=150mg/mL


I am seeing this thread just now, so I'm not sure whether anyone already mentioned this or not, but you are of there by a factor of 1000!!

150K = 150,000 Units/ml NOT 150 units/ml !
fortunately, since 1 unit usually is the same as 1 micogram, i.e 1/1000th of a milligram or mg, 150,000 units/ml DOES equal 150 mg/ml. Whew.
So at least the rest of the calculations must have been right.


I'm so sorry to read that Hans passed away. I read the rest of the thread, and I agree, you seemed to be doing the right things.


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## Maureen Las (Jul 23, 2009)

I think the calculations were probably right as she went striaght to the author of the bicillin author Marcy Rosenthal( I think that's her name )

I think Claire meant 150,000

StreisandI
just cannot figure it out but if Hans was easy to pick up that night there was probably something going on prior to the injection.; I wish we knew what. :?.........
I am just so very sorry about this..........:cry1:

Biny free little Guy :tears2:


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## 12354somebunny (Jul 23, 2009)

Hazel-mum, thanks for your input. I'm aware that the 'K' in 150K represents a unit of 1000 (i.e. 150K units = 150,000 units). And I've also come across a couple of sites which mention in passing that 1mg=1000 International Units.

Every time I analyse the situation, I come back to the possibility that I injected the drug into a blood vessel, and it travelled to his heart, leading to his passing  and from the discussion in fluffies' thread, that's very possible. I feel like I've failed Hans.


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## Maureen Las (Jul 23, 2009)

*Hazel-Mom wrote: *


> *tonyshuman wrote: *
> 
> 
> > I am guessing that 150K=150units/mL=150mg/mL
> ...


Where were you Hazelsmom when we were trying to figure out what K was = to???:?
Thanks for the info.


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## 12354somebunny (Jul 23, 2009)

*angieluv wrote: *


> I think the calculations were probably right as she went striaght to the author of the bicillin author Marcy Rosenthal ( I think that's her name )


I did ask Marcy, but she wasn't 100% sure about the conversion. She thinks that 1mg is most likely equivalent to 1,000 units (and after that, I found a couple of sites which mentioned in passing that 1mg=1000units). Conversion aside, she looked at the contents of Benacillin and was certain that it is the right version of bicillin to be used.


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## Flashy (Jul 24, 2009)

*somebunny wrote: *


> Every time I analyse the situation, I come back to the possibility that I injected the drug into a blood vessel, and it travelled to his heart, leading to his passing  and from the discussion in fluffies' thread, that's very possible. I feel like I've failed Hans.



It is natural to look at the biggest potential error we made, but I agree with Maureen. I think there was something else going on inside Hans, something that none of us, nor you could have known, and he was struggling that day, and the drug was just too much for his little body when it was already struggling and potentially failing.

I hope in time you are able to let the 'what ifs' and the guilt go because no one else other than you thinks that guilt is justified.

If you want to add me to msn at some time that's cool, but I won't ask you what happened, don't worry. We can just chat or whatever you want


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## tonyshuman (Jul 24, 2009)

*Hazel-Mom wrote: *


> *tonyshuman wrote: *
> 
> 
> > I am guessing that 150K=150units/mL=150mg/mL
> ...



Sorry I think I had a typo. I meant to say that 150k=150*K*units=150mg/ml
K as in kilo, aka kilo-units, meaning 1000 units.

I agree with angieluv and flashy that there must have been something else going on with Hans, especially after reading your description of his passing. I posted a lot of my thoughts in the fluffies' thread. We were discussing it there so that you wouldn't have to see us analyzing what was going on if you didn't want to see it yet. In particular, I did a lot of finding information and thinking out loud about it to get others' opinions on it, and not all of those thoughts I posted were 100% throught through yet--it was more of a discussion in progress than my final conclusions, if you know what I mean. 

Really, the description of his passing makes me think something else was going on and it was 100% not your fault. If it had been from the drug, we would have seen at least some muscle twitching. If it had been from the drug too, it wouldn't have been your fault in my opinion, because your intentions were to help out Hans.

I really admire you for your persistence in getting good care for Hans, and for doing things outside of your comfort zone to take care of him. I'm really afraid of needles, so if my bunnies needed injections, it would be very hard for me to give them, not to mention that you had to convince your vet it was the right thing to do. The fact that the abscess was shrinking shows that what you were doing was working. Something you couldn't see must have been at play here. He may have died, but his family was doing everything possible to try to stop that, and that showed how much you loved him. Please please don't blame yourself for it. If you want to talk about it, and what I learned from the articles I found, please PM me at any time.


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## 12354somebunny (Jul 26, 2009)

I don't think its the drug either. When we first started treatment, Hans was given daily injections for the first 3 days (to get the drug level up, as advised by Randy). If it was anything to do with the drug, I think we would have seen some reaction then.

I guess you are all correct. There may have been something else going on that I couldn't see/know about. I'm going to leave it at that, and just cherish the memories Hans left behind from now on.

Thanks, Maureen, Tracy and Claire. You have all helped me tremendously during this hard time.


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