Head Tilt - An Update

Sally, my indoor rabbit, has head tilt and very badly disorientated. She was given steroid, baytril and gut stimulant injections and is on 1 ml baytril and .3 panacur daily (liquid). Does this sound right?

Yes sounds like all bases have been covered. Hope she improves soon.

Sorry to hear this, hope she gets better soon x

I was just going to direct you to the EC thread, but see you've already found it. Hope Sally improves soon x

Fingers crossed for a quick recovery. Head tilt is nasty

Sorry to hear your bun has tilt. Hoping for a speedy recovery.

Quick question, did the tilt just appear one day or was it a gradual thing you noticed that got worse? I want to know what signs to look for.

Thanks

As he has been given Baytril I would assume your vet suspects an infection may be present in which case giving steroids is a bad idea as it will lower his immune system. Also if he does have an ear infection Baytril is usually not strong enough, the best thing to do is obtain a sample if possible.

I would also highly recommend giving him Metacam which is a non steroidal anti inflammatory and painkiller. My head tilt bun Mimi wouldn't have got through it and carried on eating throughout without that.

Is your vet rabbit savvy?

You may need to adapt your buns surroundings while he is disorientated. Take out any levels or anything he can jump on to/fall off. If he's free range as my Mimi is he may need to be temporarily confined to a smaller area to prevent him hurting himself. If he usually has a water bottle he might not be able to use it so consider changing to a bowl. Is he rolling? If so you may need to keep the bowl away from him so that he doesnt knock it over and offer it to him every half an hour or so.

Another thing to try is giving him gentle neck, shoulder and back massages to help with the pain and loosen up the muscles. Mimi absolutely loved me doing this for her and I'm sure it helped her head correct itself once she was recovered.

Keep a close eye on his 'down' eye to make sure it's clean with no debris in it. I also used lubricating eye drops in Mimi's 'up' eye as she was finding it hard to blink. Something else to discuss with your vet.

Also keep an eye out for unbeaten caecotrophs and if you spot any offer them to him as he may not be able to reach them on his own.

I hope that helps a bit :wave:

I don't think you can give metacam in conjunction with the steriod, you'd need to wait.

My vet always gives a steriod in the first instance when they suspect EC and I found comet responded really well to it. We also gave Baytril though, not becuase the vet suspected infection but more to cover all bases because of the similarity in symptoms.

margarita said:

Sorry to hear your bun has tilt. Hoping for a speedy recovery.

Quick question, did the tilt just appear one day or was it a gradual thing you noticed that got worse? I want to know what signs to look for.

Thanks

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Yes, it just happened in the evening. All the rest of the day she had been normal.

Gemmapookie said:

As he has been given Baytril I would assume your vet suspects an infection may be present in which case giving steroids is a bad idea as it will lower his immune system. Also if he does have an ear infection Baytril is usually not strong enough, the best thing to do is obtain a sample if possible.

I would also highly recommend giving him Metacam which is a non steroidal anti inflammatory and painkiller. My head tilt bun Mimi wouldn't have got through it and carried on eating throughout without that.

Is your vet rabbit savvy?

You may need to adapt your buns surroundings while he is disorientated. Take out any levels or anything he can jump on to/fall off. If he's free range as my Mimi is he may need to be temporarily confined to a smaller area to prevent him hurting himself. If he usually has a water bottle he might not be able to use it so consider changing to a bowl. Is he rolling? If so you may need to keep the bowl away from him so that he doesnt knock it over and offer it to him every half an hour or so.

Another thing to try is giving him gentle neck, shoulder and back massages to help with the pain and loosen up the muscles. Mimi absolutely loved me doing this for her and I'm sure it helped her head correct itself once she was recovered.

Keep a close eye on his 'down' eye to make sure it's clean with no debris in it. I also used lubricating eye drops in Mimi's 'up' eye as she was finding it hard to blink. Something else to discuss with your vet.

Also keep an eye out for unbeaten caecotrophs and if you spot any offer them to him as he may not be able to reach them on his own.

I hope that helps a bit :wave:

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Thank you for your reply. I asked the Vet what were the advantages of using a steroid instead of a non-steroid anti-inflammatory injection and he said it was more far reaching or similar to that effect! And it lasts longer. She's eating normally and she has a bowl of water annd is confined to a smaller area. She has another steroid injection on Friday to come

That isn't what my bunny was given and he made an excellent full recovery. My vet runs a rabbit clinic and is just amazing. Roger was on a much stronger antibiotic. Can't remember what it was called but it began with an M. I said about Baytril but Simon dismissed it, saying it was for much milder conditions that didn't need such aggressive treatment. He didn't have gut stimulant, but he had something to stop him feeling so dis-orinerated, and dizzy, and that helped him loads. He had metacam but a larger dose than that.

Topping up vibes for Sally (((((((((((((((((((((((((((healing vibes))))))))))))))))))))))))))))) It's scary enough an illness as it is, but when it comes on quick it's terrifying.

Mimzy got headtilt back in June 2012. He also did not receive steroids. My vet felt it would help him straighten his head but only for a short time, plus he was already on metacam for spondylosis. He had Baytril twice a day, meclazine twice a day and metaclopromide twice a day for almost six months. Two months into his illness we tried changing up the abx as it didn't seem to be doing anything else, but chloramphenicol only made him stop eating.
He is still tilted today but recovered.

I hope Sally will get better soon. (((((((((((((((((((hugs))))))))))))))))))))))))

It is not unusual for a corticosteroid to be given (alongside an antibiotic) in the acute stages of headtilt, especially if there are other neurological signs such as nystagmus (flicking eyes). However in my experience it is preferable to move over to a non steroidal anti-inflammatory at the earliest opportunity. Rabbits are very sensitive to the negative side effects of corticosteroids which include immuno-suppression and GI tract ulceration. Hence the use of the drug needs to be carefully monitored and restricted to very specific cases. The last thing needed is to lower the immune system of a Rabbit already fighting a disease process.

You need to scroll down to the end of this link to read about specific treatments

http://wildpro.twycrosszoo.org/S/00dis/Parasitic/Encephalitozoonosis.htm


The choice of antibiotic is something else that is never a 'one size fits all'. Vets legally have to adhere to the prescribing cascade

http://www.bsava.com/Advice/BSAVAGu...gcascadeandofflabeluse/tabid/360/Default.aspx


and so Baytril (enrofloxacin) is often the abx of choice as it is one of the few that are licensed for use in Rabbits. Marbocyl (marbofloxacin) is similar and some Vets may opt to use this instead There are other options, no antibiotic is 'stronger' than another as such. There efficacy will be based on what the specific bacteria involved is. Baytril is a good broad spectrum abx, but sometimes an additional abx or one that targets a specific bacteria may be required

Supportive nursing care and stringent hygiene, especially preventing the Rabbit from ingesting urine contaminated food/bedding, are as essential as medication and may be required for many months.

Massage and acupuncture can be useful to address the muscle dystrophy that occurs with head tilt. Eye problems may also occur and often artificial tears are required to prevent corneal ulceration as a result of 'dry eye'

Hope that your Rabbit will start to show signs of improvement soon. Did your Vet mention the importance of preventing cross contamination to other Rabbits ? As you have said you have 80 in total I think this needs to be taken into account. Any Rabbit who has had access to the area used by your Head Tilt Rabbit would need a course of Panacur too as if it is EC then is can be transmitted from EC spores excreted in the effected Rabbit's urine.

Thanks for yesterday's replies which I have only just read as phone and broadband were both out of action, thanks to Talk Talk! Well I have just got home from the Vets where she really wanted to put Sally to sleep as she could see no improvement from Monday. I told her that rabbits can recover from EC if that is what it is, as I read about them on this Forum, so the Vet agreed to give Sally her third Steroid but I can understand how she felt because Sally was thrashing about. The Vet said she had been to Congress and had the most up to date information on EC which I have no doubt about, so I am going to monitor her over the weekend and see how it goes.

Thanks Jane I will need to digest all the info a bit more and the only other rabbit in her area is her friend as they are indoors.

Can someone tell me if it is still early days with Sally and how long will the thrashing about continue for as this may give me some hope for her. Most of the time she is still, it is just when I disturb her then she starts rolling and thrashing about. My Vet feels she is suffering and wasn't very happy with waiting to see if there is an improvement. Sally is eating normally.

It is still VERY early days, and I am saddened (although unfortunately not surprised) that your vet suggested PTS.

Mimi rolled continuously for 4 weeks before she even started to show some improvement, and she still rolled occasionally for many more weeks. It is awful to see. Mimi's rolling got markedly worse when she was moved/picked up, so my vet agreed that he would monitor her progress by what I told him so that she wouldn't need to travel.

Did your vet have another look in Sally's ears? Mimi's ear infection couldn't be seen at first so he have her a shot of steroids. 2 days later she was much worse and when he re examined her ears he found the infection. Sometimes the infection can't be seen atall so it can't be discounted in Sally's case. Unless she has had bloods that confirm EC? My vet was of the opinion that most cases of head tilt are due to ear infections, and we didn't even treat for EC. Mimi made a full recovery in the end

Loads of vibes for poor Sally I personally feel that if she is still eating for herself, she wants to fight on

Gemmapookie said:

It is still VERY early days, and I am saddened (although unfortunately not surprised) that your vet suggested PTS.

Mimi rolled continuously for 4 weeks before she even started to show some improvement, and she still rolled occasionally for many more weeks. It is awful to see. Mimi's rolling got markedly worse when she was moved/picked up, so my vet agreed that he would monitor her progress by what I told him so that she wouldn't need to travel.

Did your vet have another look in Sally's ears? Mimi's ear infection couldn't be seen at first so he have her a shot of steroids. 2 days later she was much worse and when he re examined her ears he found the infection. Sometimes the infection can't be seen atall so it can't be discounted in Sally's case. Unless she has had bloods that confirm EC? My vet was of the opinion that most cases of head tilt are due to ear infections, and we didn't even treat for EC. Mimi made a full recovery in the end

Loads of vibes for poor Sally I personally feel that if she is still eating for herself, she wants to fight on

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Thanks for your reply. Was Mimi on Baytril for thr ear infection? Sally is on 1 ml per day which I think is quite a high dose. The Vet did not inspect her ears. Just a week ago I had a cold. Could it be connected with that?

tonibun said:

Thanks for your reply. Was Mimi on Baytril for thr ear infection? Sally is on 1 ml per day which I think is quite a high dose. The Vet did not inspect her ears. Just a week ago I had a cold. Could it be connected with that?

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I don't think it can be connected with your cold.

Mimi was on Marbocyl, can't remember the dose exactly sorry. A sample was taken from her ear to find out what the best abx to use were. She was also on Metacam and a drug called Meclozine, which is a human anti vertigo drug to help with the dizziness.

Is Sally still eating/drinking/pooing OK? How is her mobility? :wave:

Gemmapookie said:

I don't think it can be connected with your cold.

Mimi was on Marbocyl, can't remember the dose exactly sorry. A sample was taken from her ear to find out what the best abx to use were. She was also on Metacam and a drug called Meclozine, which is a human anti vertigo drug to help with the dizziness.

Is Sally still eating/drinking/pooing OK? How is her mobility? :wave:

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Yes she is eating all that I give them and drinking. I assume she is pooing as she lives with Max so can't monitor. Mobility-wise she is bad. It is when she tries to move to get to the food etc that she is so disorientated. The Vet gave her a slightly higher dose of Steroid, 1/2 ml, today but I am wondering if that is the way we should be going.

tonibun said:

Yes she is eating all that I give them and drinking. I assume she is pooing as she lives with Max so can't monitor. Mobility-wise she is bad. It is when she tries to move to get to the food etc that she is so disorientated. The Vet gave her a slightly higher dose of Steroid, 1/2 ml, today but I am wondering if that is the way we should be going.

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When my vet initially gave Mimi a steroid I found that she seemed to almost immediately improve and liven up a bit, but then the next day was much worse. Whether that was down to the steroid I don't know, but after the infection became apparent he switched to Metacam instead. Maybe discuss doing this with your vet? Metacam is a painkiller as well, and Mimi always ate a lot more and was more comfortable after her dose of Metacam.

Is there another rabbit savvy vet in your area who you can get a second opinion off? Unfortunately head tilt is still an area that a lot of vets aren't clued up on

Not raising my hopes up too much but I think I see a slight improvement in Sally! The grass is growing really well outside my front door so I have just picked a big handful for them and Sally was stuffing it in, all freshly washed by last night's rain! I rang the Vets to let them know as they like to get updates.