feeding with labrynthitis

Hi all, just hoping for some advice. Our poor girl has labrynthitis, presenting as head tilt with severe dizziness and disorientation. We've housed her in a small transport cage with rolled towels to prevent her from hurting herself for the last three days as she has been unable to move much without rolling over and thrashing around to right herself. It's very distressing to see. We are administering penicillin injections , sub cut fluids, Metaclopromide and metacam but so far very little change. On the positive side she has been eating by herself up until now so we haven't had to syringe feed her. She hates any form of syringe administration and picking her up at the moment causes her to become disoriented and go into a spinning fit so we've been keen to avoid it, but today she seems a little worse and hasn't been eating so I think we're going to have to try though I've no idea how we will manage it. Just wondering if anyone had experience of managing rabbits with this condition and any advice?

Damian

Poor Bunny From the medication given I am assuming your Vet has diagnosed a middle ear infection leading to the vestibular symptoms ?

How frequently is she having the penicillin injections ? Any inappetence that occurs when a Rabbit is on a Penicillin type abx really merits another Vet consultation. It may be that all the dizziness is making her feel nauseous, even though Rabbits cannot actually vomit they probably do experience nausea when they have any problem effecting their vestibular system.Metoclopramide should help reduce nausea. However, a Penicillin abx does carry a higher risk of causing gut dysbiosis which can lead to enteritis. Hence I feel a Vet's opinion needs to be sought again ASAP now that your Rabbit has stopped eating.

Syringe feeding a Rabbit severely effected by vestibular disease is also risky as there is a risk that the Rabbit may aspirate a feed should rolling occur. I have found that leaving the Rabbit on the floor, wrapping him/her firmly in a towel and covering their eyes to avoid any visual stimulation can lessen the risk of rolling and thus make a syringe feed more doable. It is usually changing position, eg being picked up, that can trigger rolling. It is often a two person job to do the syringe feeds, one to secure the Rabbit in the towel and the other to administer the feed.

Did your Vet rule out EC as a possible factor ? This too can present with vestibular symptoms. I am wondering if the Vet also suggested giving a 28 day course of Fenbendazole (Panacur/Lapizole) too as a precaution ?

I hope that your Rabbit will show some signs of improvement soon.

Hi, thanks very much for the reply. Actually Twickenham Surgery are our vets . Yes Phoebe is also on Panacur In case it's EC. She has only produced tiny little rock hard pellets over the last few days so some activity but poor, although up until now she hasn't shown any sign of usual discomfort associated with stasis, and has continued to take some food . She still wants to eat but her balance is so much worse today that she just can'e without falling. You're right, it's the changing position that affects her. We were taking her out to give her her oral meds but have been trying to do it while leaving her in her cage for the last two days to try and avoid the vertigo and subsequent nystagmus episodes as it takes her time to recover, but think we're just going to have to bite the bullet. Nearly cried just now as every time I give her the sub cut fluids it seems to go all over her coat even when I'm sure the needles in. I hate doing it to her, but then feel I failed her when it doesn't appear to go in as it's so important. She's having the penicillin once a day, but with no real evidence of improvement yet, although it's only day three.

Mayhew said:

Hi, thanks very much for the reply. Actually Twickenham Surgery are our vets . Yes Phoebe is also on Panacur In case it's EC. She has only produced tiny little rock hard pellets over the last few days so some activity but poor, although up until now she hasn't shown any sign of usual discomfort associated with stasis, and has continued to take some food . She still wants to eat but her balance is so much worse today that she just can'e without falling. You're right, it's the changing position that affects her. We were taking her out to give her her oral meds but have been trying to do it while leaving her in her cage for the last two days to try and avoid the vertigo and subsequent nystagmus episodes as it takes her time to recover, but think we're just going to have to bite the bullet. Nearly cried just now as every time I give her the sub cut fluids it seems to go all over her coat even when I'm sure the needles in. I hate doing it to her, but then feel I failed her when it doesn't appear to go in as it's so important. She's having the penicillin once a day, but with no real evidence of improvement yet, although it's only day three.

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Perhaps you could try hand feeding her whilst she is in her cage before attempting syringe feeds. Some fresh herbs may tempt her, especially coriander. You could also pull up some grass for her if you have access to a grassed garden. With any sort of vestibular disease things can get worse before they get better. It really is a nasty condition. It sounds as though you are doing everything possible to help her. I really hope that there will be some improvement soon.

Thanks. We took her out and syringe fed her lying on her side with the help of a towel and covering her eyes which worked well, and we got 20mls of critical care and 20mls of water and pineapple juice into her. When we put her back though we had an awful rolling fit with her unable to get her bearings of balance for ten minutes. Finally just managed to settle her by forcefully holding her against the side of the cage / towel rolls and wedging a small roll by the side of her head. It's just so stressful.

Just had to run into their room because she was in a roll again. The vet did give us rectal diazepam to give if she couldn't stop rolling, but I'm apprehensive

Mayhew said:

Just had to run into their room because she was in a roll again. The vet did give us rectal diazepam to give if she couldn't stop rolling, but I'm apprehensive

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I've only just seen your thread and I'm so sorry to hear about your rolling bunny. I have looked after several head tilt bunnies over the years and I think the protocol given to you by Twickenham Vets (they are also my own vets ) seems very sound and sensible.

When one of my little ones had seizures recently, I asked the vet for some rectal diazepam, as it's so very distressing for both you and the rabbit when they roll around. Perhaps give it a go, with two of you, if you feel you can. It may give her a bit of a break ...

Good luck

Mayhew said:

Just had to run into their room because she was in a roll again. The vet did give us rectal diazepam to give if she couldn't stop rolling, but I'm apprehensive

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Poor Bun

Did you give the diazepam spansule ? I have had to administer them to an epileptic Rabbit but thus far I have not had to use them in cases of vestibular disease.

How are things this morning ?

When we were in the same situation with Lilly (one vet told us to put her to sleep, I walked out, never been back since). We fed her herbs in little pieces,and blades of grass. And we got a baby bowl so I could put baby food, the fruit ones, and liquidised pellets. Put a teaspoon amount in the bowl and you can tip it up so that they can lick it.
It is so upsetting watching your bunny go thru this. Seeing them roll. I cried buckets. X

Hi, thanks for the messages guys. It helps to know other people have been through it and are there! We had a very bad couple of hours after syringing last night, but finally managed to settle her with the help of some additional rolled towels to stabilise her. When she eventually settled it was leaning against a side towel roll with her head down and that's the position she stayed in all night without moving - she just looked so exhausted. As with the last few mornings I dreaded getting up in case she had died over night. On checking her she was in the same position and tired but alert, and tried to raise her head when i went in. After some stroking and words of encouragement she managed to sit up and groom herself for a bit before having to lay down again, with her eye flicking (nystagmus) but i was encouraged that she managed to get up and had the drive to wash. We didn't give her the diazepam in the end as it depresses respiration and vet said we would have to take her straight there if we gave it, and being a weekend that would have been a problem. We're about to give her another feed, meds and sub cut fluids now. I'll try and give her as much critical care as i can to avoid disturbing her again too much. Thanks again for the support. Without going into details we've been through something very similar not that long ago, so this is like a recurring nightmare! I just feel physically sick and exhausted with worry. x

Mayhew said:

Hi, thanks for the messages guys. It helps to know other people have been through it and are there! We had a very bad couple of hours after syringing last night, but finally managed to settle her with the help of some additional rolled towels to stabilise her. When she eventually settled it was leaning against a side towel roll with her head down and that's the position she stayed in all night without moving - she just looked so exhausted. As with the last few mornings I dreaded getting up in case she had died over night. On checking her she was in the same position and tired but alert, and tried to raise her head when i went in. After some stroking and words of encouragement she managed to sit up and groom herself for a bit before having to lay down again, with her eye flicking (nystagmus) but i was encouraged that she managed to get up and had the drive to wash. We didn't give her the diazepam in the end as it depresses respiration and vet said we would have to take her straight there if we gave it, and being a weekend that would have been a problem. We're about to give her another feed, meds and sub cut fluids now. I'll try and give her as much critical care as i can to avoid disturbing her again too much. Thanks again for the support. Without going into details we've been through something very similar not that long ago, so this is like a recurring nightmare! I just feel physically sick and exhausted with worry. x

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It really is a horrible condition, I empathise with you.

Whilst the use of corticosteroids in Rabbits is not something that should ever be done without very careful consideration there are some cases whereby the risks corticosteroids have re adverse side effects, especially immuno-suppression, are risks that have to be taken. In severe cases of vestibular disease a NSAID (eg Metacam) may not be enough to reduce the inflammation in the CNS that is causing all the rolling/nystagmus etc. Ideally there should be a 24 hour gap from the last dose of Metacam before a shot of a corticosteroid is given so I dont know if you feel that contacting the OOH Vet today re this might be appropriate ?

I have had a few Rabbits who have been prescribed a corticosteroid, alongside abx and fenbendazole to address the severe vestibular symptoms caused by EC. In all cases but one the rolling and nystagmus resolved quickly. The use of corticosteroids as an anti-inflammatory in cases of EC with vestibular symptoms is mentioned on this link written by an Exotics Vet Specialist:

http://www.gwexotics.com/wccms-resources/a/5/0/e/77554b90-a660-11e0-a685-0050568626ea.pdf

Ok so just an update - I'm hoping this thread will help anyone with similar problems in the future. We took Phoebe out of the cage again this morning and were successfully able to syringe feed her wrapped in a towel lying on her side. We managed to administer two 20 ml syringes of CC and 20mls of water mixed with pineapple juice, as well as all her meds, and the additional 20mls of fluid and Penicillin given by SC injection. We then managed to get her back in the cage without a rolling fit by quickly wedging another rolled towel alongside her, so she didn't have room to roll. This seemed to be quite effective, and she was sitting up (on a slant) washing herself within a couple of minutes. So a successful morning treatment, and we can relax a little for now. When we took her out there were some tiny little droppings, but a little more moist then they have been, so she continues to have some gut activity although minimal. She seems comfortable though, and now we have away to syringe feed her hopefully we can keep on top of it.

@Jack-Janes - I did specifically ask our (wonderful) vets about corticosteroids, but their view is that it's controversial because of the immuno suppressant effects, and they prefer not to give it initially, but will consider as a later course of action. I read a medirabbit article which I forwarded to them that suggests their use in the first 5 days (acute phase) but not longer due to the suppressant effects. This is day 4 of Penicillin, but if she hasn't shown any improvement by tomorrow I will discuss with them again.

Mayhew said:

Ok so just an update - I'm hoping this thread will help anyone with similar problems in the future. We took Phoebe out of the cage again this morning and were successfully able to syringe feed her wrapped in a towel lying on her side. We managed to administer two 20 ml syringes of CC and 20mls of water mixed with pineapple juice, as well as all her meds, and the additional 20mls of fluid and Penicillin given by SC injection. We then managed to get her back in the cage without a rolling fit by quickly wedging another rolled towel alongside her, so she didn't have room to roll. This seemed to be quite effective, and she was sitting up (on a slant) washing herself within a couple of minutes. So a successful morning treatment, and we can relax a little for now. When we took her out there were some tiny little droppings, but a little more moist then they have been, so she continues to have some gut activity although minimal. She seems comfortable though, and now we have away to syringe feed her hopefully we can keep on top of it.

@Jack-Janes - I did specifically ask our (wonderful) vets about corticosteroids, but their view is that it's controversial because of the immuno suppressant effects, and they prefer not to give it initially, but will consider as a later course of action. I read a medirabbit article which I forwarded to them that suggests their use in the first 5 days (acute phase) but not longer due to the suppressant effects. This is day 4 of Penicillin, but if she hasn't shown any improvement by tomorrow I will discuss with them again.

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That sounds like a very sensible course of action. I am glad that the most recent feed/medicating went better with no rolling xx

Mayhew said:

Ok so just an update - I'm hoping this thread will help anyone with similar problems in the future. We took Phoebe out of the cage again this morning and were successfully able to syringe feed her wrapped in a towel lying on her side. We managed to administer two 20 ml syringes of CC and 20mls of water mixed with pineapple juice, as well as all her meds, and the additional 20mls of fluid and Penicillin given by SC injection. We then managed to get her back in the cage without a rolling fit by quickly wedging another rolled towel alongside her, so she didn't have room to roll. This seemed to be quite effective, and she was sitting up (on a slant) washing herself within a couple of minutes. So a successful morning treatment, and we can relax a little for now. When we took her out there were some tiny little droppings, but a little more moist then they have been, so she continues to have some gut activity although minimal. She seems comfortable though, and now we have away to syringe feed her hopefully we can keep on top of it.

@Jack-Janes - I did specifically ask our (wonderful) vets about corticosteroids, but their view is that it's controversial because of the immuno suppressant effects, and they prefer not to give it initially, but will consider as a later course of action. I read a medirabbit article which I forwarded to them that suggests their use in the first 5 days (acute phase) but not longer due to the suppressant effects. This is day 4 of Penicillin, but if she hasn't shown any improvement by tomorrow I will discuss with them again.

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I am so glad you found a way forward which sounds much more hopeful today!

I totally agree with your vet about not giving the steroid injections. It caused a great deal of havoc in one of my buns (in my early days of bun-keeping when vets gave them more often) and I would be extremely cautious. It can sometimes cause more problems than it proposes to solve.

Continued good luck to you!