Head tilt but it's not E Cuniculi - Help!

[bunny momma]

Sending more vibes for Dexter.

 

[joey&boo]

I'm pleased he is moving in the right direction

 

[dex179]

Thank you all for your concern

Update: His appetite is improving still and he's able to eat by himself if you put the food bowl either side of him. Sadly he still has the head tilt which is the most likely cause of him not moving too much. He literally can do a 360 but won't really move much from that spot. The only lucky thing is that he hasn't soiled himself every day.

I'm continuing with the panacur, anti biotics for middle ear infection, and metacam for the time being.

I have a question if you don't mind helping me with - if it's not EC or middle ear infection, what do you think could be the cause of his head tilt? The vets thing it's something in his brain. Or do you think it could be EC or middle ear infection, but I need time for it to clear up? My main concern is his lack of mobility

Another question I have - is it harmful for rabbits to be on metacam longer term? I'm just wondering whether that is what is helping him with his appetite, but I don't want to keep giving it to him if overall it is detrimental is to health. Any thoughts?

Thanks

 

[bunny momma]

If the Medicam is dosed correctly, your bunny can be on it long term. High doses may impact kidney function if given long term, depending on the age and health of the bunny, so your vet may want to monitor him.
If he is eating, that is always a good sign. It is also good he is keeping himself clean.
Even after the infection or ec clears, there may be residual inflammation and discomfort which the medicam can help. Though he also may need more time for the medication to continue to work, and a different abx may be an option.
Dexter may need time to get used to his new perspective of the world. His head tilt can still improve. Does he have any eye movements, rolling, twisting, or falling over; that may or may not be related to handling?

Sending lots of positive vibes he will continue to improve.

 

[InspectorMorse]

Thank you all for your concern

Update: His appetite is improving still and he's able to eat by himself if you put the food bowl either side of him. Sadly he still has the head tilt which is the most likely cause of him not moving too much. He literally can do a 360 but won't really move much from that spot. The only lucky thing is that he hasn't soiled himself every day.

I'm continuing with the panacur, anti biotics for middle ear infection, and metacam for the time being.

I have a question if you don't mind helping me with - if it's not EC or middle ear infection, what do you think could be the cause of his head tilt? The vets thing it's something in his brain. Or do you think it could be EC or middle ear infection, but I need time for it to clear up? My main concern is his lack of mobility

Another question I have - is it harmful for rabbits to be on metacam longer term? I'm just wondering whether that is what is helping him with his appetite, but I don't want to keep giving it to him if overall it is detrimental is to health. Any thoughts?

Thanks

EC affects the brain as well as the rest of the central nervous system leading to the vestibular symptoms and hind leg paresis. EC also affects the kidneys and the lenses of the eyes. It has been known to affect the liver, heart and GI tract too. Middle ear infections (otitis media) can affect the balance mechanism leading to vestibular symptoms. Otitis media can cause abscess formation and also progress to otitis interna, inner ear infection, which can result in brain abscesses too.

Medirabbit

Metacam is a non steroidal anti inflammatory analgesic. For some chronic conditions it might be necessary for it to be prescribed long term. It can be harsh on the kidneys, but the Vet needs to weigh up risks v benefits and prescribe the lowest dose possible to provide adequate anti inflammatory analgesic cover whilst trying to minimise the burden on renal function. As EC impairs renal function this is especially relevant. The drug might still have to be given at the safest dose rate possible in order for the Rabbit to have a reasonable quality of life.

Drug Focus: Meloxicam

Creating better tomorrows for all pet rabbits Drug Focus: Meloxicam By Richard Saunders, RWAF Veterinary Adviser (This article was first published in Rabbiting On, Autumn, 2014) Photo: S Edwards. Meloxicam is a very useful drug in rabbits Generic Drug Name: Meloxicam Trade names include...

rabbitwelfare.co.uk

https://docs.boehringer-ingelheim.com/MSDS/Metacam%20Oral%20Suspension%20PI%202021.pdf

Head tilt can be permanent. It is then a case of assessing how the individual Rabbit copes with the disability. Some do, some are not able to have a reasonable QOL. Each case needs to be assessed individually.

Edited to add that it can be beneficial to introduce physiotherapy, laser therapy and acupuncture to try to reduce the muscle distortion caused by the head being permanently tilted. Physio can also help re-programme the neural pathways in the brain thus improving mobility. Specific types of physio are needed so it is advisable to consult a Veterinary physiotherapist

Helping Hands Veterinary Physiotherapy | Rabbits

www.helpinghandsvetphysio.co.uk

 

[dex179]

If the Medicam is dosed correctly, your bunny can be on it long term. High doses may impact kidney function if given long term, depending on the age and health of the bunny, so your vet may want to monitor him.
If he is eating, that is always a good sign. It is also good he is keeping himself clean.
Even after the infection or ec clears, there may be residual inflammation and discomfort which the medicam can help. Though he also may need more time for the medication to continue to work, and a different abx may be an option.
Dexter may need time to get used to his new perspective of the world. His head tilt can still improve. Does he have any eye movements, rolling, twisting, or falling over; that may or may not be related to handling?

Sending lots of positive vibes he will continue to improve.

Thank you for letting me know about the medicam. I'll have to review his dosage, but the vets have prescribed him 1ml and he weights about 1.7kg..does that sound right?

What do you mean when you say a different "abx"? He's been on panacur for nearly 6 weeks and I wasn't sure if it was helping so I stopped as of yesterday - do you think I should just continue it until it's finished?

So the last time (a few weeks back) Dexter went to the vets they said his twitching eye movements had gone - I checked yesterday and couldn't see it. He's not rolling or twisting. He doesn't fall over but his left leg (his head and body tilts to the left) looks very weak and limp. He doesn't move too much but can just about reach his food that's put right in front of him.

When I do push him a bit he does hop but will only do so when I push him

For the time being I've been managing to largely keep his bottom dry

 

[dex179]

Hi All

So update so far is:
*Dexter is still eating reasonably well, as long as his bowl is in front of him.
*he still has his head tilt
*His mobility is very limited. He doesn't hop about anymore, but pretty much only moves 360 degrees in that spot
*I am still giving him antibiotics for the possible middle ear infection
*I've stopped giving him panacur as of yesterday (it's been 6 weeks since I start the course)
*I still give him 1ml of metacam per day (he's 1.7kg)
*His eyes are very gunky and the fur is starting to come off - pics are attached - please help

I was wondering your opinions on what I can do about his eye? The doctors prescribed isaathal a few months back but I did a couple of those courses and it didn't work. Is there something I can do to soothe his eyes? Do you think he's in pain?

Also - When I last spoke to the vets and they mentioned possibly thinking about putting Dexter to sleep. But if he's still eating well and his bottom isn't in a bad state, does that even make sense? Yes his mobility isn't good, his eyes are in a bad state and he's got a head tilt, but he still lies flat out and chills. How would I know when it's time? Because right now given his appetite I can't see why I wouldn't keep him going.

Thank you all for your help and for all the advice

 

[tonibun]

Poor boy! He looks very sorry for himself doesn't he. 10 is a good age for a Rabbit and you are trying so hard to help him get better. You obviously care deeply for him. x

 

[dex179]

Poor boy! He looks very sorry for himself doesn't he. 10 is a good age for a Rabbit and you are trying so hard to help him get better. You obviously care deeply for him. x

Yes, I always call him my first born (I also have a human daughter who is younger!)

Given all his health conditions over the years, even the vets are surprised he's going strong. The only reason he fell ill is because I took my first holiday in 4 years (which I delayed because I couldn't find an appropriate rabbit boarder), but in that time he fell ill and contracted this head tilt. Obviously I deeply regret going away now because I'm fairly certain he wouldn't have fallen ill if he was at home rather than at the boarders

I'm just trying to keep him alive at the moment

 

[Omi]

I've re-read your thread and it does seem that Dexter has made some improvement, especially that he can now find his food and eat for himself and also that he can be encouraged to hop a small amount. It may be that the head tilt will not improve further, but only more time will tell on that. Recovery from head tilt will vary from rabbit to rabbit.

What I would do is to get your vets to try a different eye medication. His eyes do look very sore and I think they will be very uncomfortable for him. It should be possible to treat this I think.

 

[Shimmer]

I would also ask about eye meds.

You may need to keep going with the Panacur. It can take more than one round of (28 day) treatment to get on top of the EC (if it's confirmed / likely to be EC). Check with your vet, but if there's no other reason to stop (ie liver / kidney issues), I would keep going. Panacur just reduces the parasite loading - it doesn't get rid of it completely. There's also the risk of reinfection through contaminated urine as the parasite is shed in urine.

My worst case of EC was on meds for around 9 months. She eventually got back on her feet and outside again, with a minor head tilt and a slight limitation on jumping on things - but otherwise most people wouldn't have noticed anything wrong. She hopped through the front door one day as normal, and by the time she had gone through the lounge, she had lost the use of her back legs. By the time she got to the kitchen, her head was practically stuck to her shoulder and she was unable to do anything for herself. So there is hope, and Dexter does seem to be improving. I found it best to compare progress week on week, but expect some weeks to go backwards.

You are doing a brilliant job of caring for him.

 

[InspectorMorse]

Has the Vet checked his eyes for corneal ulceration ? Isathal isn’t very helpful for treating corneal ulcers, chloramphenicol is better as it penetrates the cornea.

His nasolacrimal ducts might be blocked too, which would exacerbate the problem.

When was the last time a Vet looking INTO his ear canals ? If there is infection in the middle ear by now there could also be some visible pus in the outer ear which can be seen using an otoscope or, in severe cases, just with the naked eye.

What strength Metacam are you giving ? The 0.5mg/ml Cat one or the 1.5mg/ml Dog one ?

 

[dex179]

Has the Vet checked his eyes for corneal ulceration ? Isathal isn’t very helpful for treating corneal ulcers, chloramphenicol is better as it penetrates the cornea.

His nasolacrimal ducts might be blocked too, which would exacerbate the problem.

When was the last time a Vet looking INTO his ear canals ? If there is infection in the middle ear by now there could also be some visible pus in the outer ear which can be seen using an otoscope or, in severe cases, just with the naked eye.

What strength Metacam are you giving ? The 0.5mg/ml Cat one or the 1.5mg/ml Dog one ?

I'm going to the vets shortly so will discuss the eye problem. i thought the isaathal was treatment for the ulcer? Will need to check

His ducts have always been blocked - is it the case he needs to flush it?

To be fair the vets looked into his ear last time and there wasn't any pus - so sounds like this isn't the case that he has a middle ear infection?

I'm using the 1.5mg/ml dog metacam. I looked at the leaflet yesterday again and it says that the dosage should be 1kg=0.2mg meloxicam. So if Dexter is 1.7kg, I should be giving him 0.34ml of metacam?? The vets prescribed 1ml and I'm not sure why the high dosage apart from maybe to really give heavy pain relief? I'm confused

 

[InspectorMorse]

I'm going to the vets shortly so will discuss the eye problem. i thought the isaathal was treatment for the ulcer? Will need to check

His ducts have always been blocked - is it the case he needs to flush it?

To be fair the vets looked into his ear last time and there wasn't any pus - so sounds like this isn't the case that he has a middle ear infection?

I'm using the 1.5mg/ml dog metacam. I looked at the leaflet yesterday again and it says that the dosage should be 1kg=0.2mg meloxicam. So if Dexter is 1.7kg, I should be giving him 0.34ml of metacam?? The vets prescribed 1ml and I'm not sure why the high dosage apart from maybe to really give heavy pain relief? I'm confused

Re Meloxicam ( Metacam )

Drug Focus: Meloxicam

Read Richard Saunders' Meloxicam Focus Piece today. Explore Dosage, Uses, Risks and more.

rabbitwelfare.co.uk

Re tear duct flushing - the Vet could attempt to do it but if the problem is due to elongated tooth roots it might not be successful. As would also be the case if the ducts have a lot of scar tissue from longterm problems. So the symptoms would just have to be managed - twice daily eye bathing, using a barrier ointment around the eyes to protect the skin, apply abx eye drops if active infection present


Re Isathal v Chloramphenicol for eye ulcer treatment. CMP has better corneal penetration than Isathal so is likely to be more effective when treating eye ulcers.
The Vet also needs to look into what the primary cause of the ulcers might be.

Re the ear infection- just because there is no pus visible in the outer ear does not mean that there isn’t a middle ear infection. Diagnosis of a middle ear infection can only be confirmed by skull radiographs/ CT scans

 

[dex179]

So the symptoms would just have to be managed - twice daily eye bathing, using a barrier ointment around the eyes to protect the skin, apply abx eye drops if active infection present

@InspectorMorse - could you give me more details on how to bathe the eye, what ointment I could use and what eye drops you think I should think about?

So I took Dexter to the vets and he said a few things:
*He doesn't think it's a middle ear infection. He looked into Dexter's ear and although there was a lot of wax, he couldn't see any pus. Although yes agreed we need to do scans to be sure. Dexter has been on antibiotics for ear infection for more than a few weeks already.
*He doesn't think it's EC - we did a blood test and results came back to say he didn't have EC (although it's not 100% conclusive, the levels of it shown in Dexter's system indicated it wasn't EC). Based on blood test and the fact we've been on panacur for 6 weeks, the vet did not prescribe more panacur. Do you think I should challenge this?
*Dexter's eyes - vet thinks it is the tear duct and said they can flush it. But Dexter's always had this problem because of his dental issues so I'm reluctant to put him through this. Still need to think about it.
*The vet did say maybe metacam long term would work - he reduced the dosage from 1ml to 0.6ml per day.

The vet also talked about quality of life - when do you know it's time? Any advice would be appreciated. Dexter is eating strong but basically barely moves so is not mobile.

 

[InspectorMorse]

I think it’s impossible for anyone but the care giver to form a true picture of QOL. For me the Rabbit needs to still show interest in their surroundings, be responsive to any interaction we initiate. I think QOL has to be more than just eating and sleeping. Also, if the Rabbit needs a lot of hands on care to make sure they remain clean and issues like urine scald do not occur then they need to be the type of Rabbit who is chilled out about being handled. A Rabbit who hates being picked up and handled a lot would have to endure it several times a day every day. I would not consider this to be part of a good QOL. What I am trying to say is there is no one size fits all and QOL judgements can only be made on an individual case basis.

The tear duct flushing can be attempted whilst the Rabbit is awake. I am doubtful that it would be successful if it is due to dental problems. Some pus might be cleared, but it will just recur. I would suggest managing symptoms as described in my previous post would be the best way forward. If he tries to move does he fall over or roll ? If his immobility is due to him feeling very dizzy then giving a travel sickness drug such as meclizine can help.

Immobility can lead to a build up of calcium deposits in the bladder. This can present with symptoms such as urinary incontinence, straining to wee, blood in urine,UTIs, bladder stones. So it’s important to monitor wee output and watch out for any signs of ‘sludgy wee’

 

[Omi]

I would also ask about eye meds.

You may need to keep going with the Panacur. It can take more than one round of (28 day) treatment to get on top of the EC (if it's confirmed / likely to be EC). Check with your vet, but if there's no other reason to stop (ie liver / kidney issues), I would keep going. Panacur just reduces the parasite loading - it doesn't get rid of it completely. There's also the risk of reinfection through contaminated urine as the parasite is shed in urine.

My worst case of EC was on meds for around 9 months. She eventually got back on her feet and outside again, with a minor head tilt and a slight limitation on jumping on things - but otherwise most people wouldn't have noticed anything wrong. She hopped through the front door one day as normal, and by the time she had gone through the lounge, she had lost the use of her back legs. By the time she got to the kitchen, her head was practically stuck to her shoulder and she was unable to do anything for herself. So there is hope, and Dexter does seem to be improving. I found it best to compare progress week on week, but expect some weeks to go backwards.

You are doing a brilliant job of caring for him.

Regarding stopping the Panacur, I would take note of what Shimmer says based on her experience. It's sometimes very difficult to diagnose EC, even after a blood test. Sometimes it's the case that it's better to assume that it's a strong possibility and therefore, if not contra-indicated, it is better to continue the medication.

Has the vet said if the problem with Dexter's eye is definitely an ulcer?

If the vet doesn't think it's an ear infection and also doesn't think it's EC, has he said what he thinks it is?

Personally, I would be cheered by the fact that Dexter has made some improvement.

Does your vet see and treat a lot of rabbits?

 

[Orenoko]

Just popping in to add a few comments as I dealt with head tilt as well - it is definitely a long term journey and it may take a while to see progress. Only you will know if it is fair to your boy to keep going. It sounds like he is making a bit of an improvement but often long term medication is needed to really kick-start the improvement. As your boy is 10 it may be that you just spoil him and keep him as comfortable as possible in the short to medium term and see how he gets on.

You can get chloramphenicol online without prescription (rightly or wrongly) in ointment or drop form. I have used it before on my vet's advice as it was about a fifth of the price the vet would charge. Re bathing the eye, warm compress may help if Dexter will tolerate that. I used to have to give treats while cleaning to soften the blow! I did also deal with some fur loss around the cheek and eye as my tilty bun Teddy became a bit dribble. I kept everything as clean as possible and it did grow back once he improved.

I also used meclizine, again ordered online but I can't remember where now. I would have to crush it as it came in tablet form. It seemed to make a difference. In the end my boy ended up on palliative care and had steroid injections which absolutely transformed him, but obviously took their toll so I would never recommend that without a frank discussion with your vet first.

 

[SarahP]

I have given Metacam long term, for both rabbits and lots of guinea pigs. I have never had an issue with giving it long term and my view is that the benefits outweigh the possibility of side effects..

 

[dex179]

The tear duct flushing can be attempted whilst the Rabbit is awake. I am doubtful that it would be successful if it is due to dental problems. Some pus might be cleared, but it will just recur. I would suggest managing symptoms as described in my previous post would be the best way forward. If he tries to move does he fall over or roll ? If his immobility is due to him feeling very dizzy then giving a travel sickness drug such as meclizine can help.

No he doesn't fall over or roll. He's actually been a tiny bit more active today - getting up, lying down, inching around a bit more

Regarding stopping the Panacur, I would take note of what Shimmer says based on her experience. It's sometimes very difficult to diagnose EC, even after a blood test. Sometimes it's the case that it's better to assume that it's a strong possibility and therefore, if not contra-indicated, it is better to continue the medication.

Has the vet said if the problem with Dexter's eye is definitely an ulcer?

If the vet doesn't think it's an ear infection and also doesn't think it's EC, has he said what he thinks it is?

Personally, I would be cheered by the fact that Dexter has made some improvement.

Does your vet see and treat a lot of rabbits?

In that case I'm going to email the vets to see if I can get mor Panacur. The vet simply said it's most likely not EC because of the blood test results and the fact it doesn't appear EC has cleared up after 6 weeks treatment

He didn't say it was an ulcer, but just said the solution to the eye was to flush the tear duct. Given what @InspectorMorse said in an earlier post, I'm not sure it would help as it is most likely caused by his dental problems. He's always had teary eyes but I've never seen it get this bad before.

So the vets thinks it's a neurological problem, something wrong with his brain. So clearly nothing we can do there

Honestly I think he's been a tiny bit brighter today and eating strong. He's moved a tiny bit more, but not really due to hopping around - most likely due to simply getting up and lying down which changes positions.

Hmmm not sure if they treat a lot of rabbits...my rabbit is very popular at the surgery so maybe they don't see many?! or maybe it's because he goes in too frequency! I don't think they are listed as rabbit friendly on the rabbit welfare website, but I've always gone to the medivet hospital. I always thought that you can't switch practices if you're registered at one? Because there is a listed rabbit friendly practice even closer to me - do you think it's worthwhile getting a second opinion at this stage?