My Rabbit is being treated for E.cuniculi (vet won't give NSAID or ABX!)

Some history and context:

Thunder is 1kg, about 18 months old and has been a very healthy and happy rabbit (he's one of 4 rabbits we have).



Last Friday, I went to the cage to see Thunder as I normally do and his head was rolling, eyes had horizontal nystagmus and he seemed a bit 'out of it'. My dad rushed him to the vets within minutes and the vet told me on the phone that he had E.cuniculi and I have two options: PTS or give him panacur and critical care. But she said it didn't look good.

I chose to treat him of course, and within 2 days he was standing up on both legs, cleaning himself, only a mild head tilt, strong legs, excellent appetite and pooing and peeing normally. No signs of weakness, tremors, incontinence.

A day after, his head tilt went 90 degrees and under. He now has difficulty landing on his feed and just continuously rolls until he gives up.

He's improved in every other way except the rolling and head tilt.

His horizontal nystagmus has gone! - is this a good sign?

Well, I don't know, because I've been researching neurobiology textbooks and they say that horizontal nystagmus is more often associated with inner ear infection and peripheral vestibular disorder. Although I know CNS related nystagmus can appear as horizontal, too.

But the fact that the nystagmus disappeared within days means that the brain adapted (but he still has head tilt and can't find his feet). And what I learned is that nystagmus related to brain pathology does not just go away like that (unless the inflammation is settling in the CNS).

"Nystagmus of peripheral origin often disappears a few days after its appearance because of compensation by other balance systems (cerebellum, vision), but sometimes it can be induced by altering the head position."

Click to expand...

[1].

Anyway, it makes me really concerned that the vet has missed an ear infection...

At first, I phoned the PDSA a few days ago after researching on here, and the nurse there said that why would I give him a NSAID when it's an infection? I told her to reduce inflammation and damage. But she would not listen and did not understand apparently... She said, it's an infection, you just need to treat that.

Today, I phoned the vet asking for antibiotics to cover the possibility of an ear infection. And I had the talk about 'quality of life' and PTS (they've not seen him since Friday). I said that many other people have had rabbits recover from this (even worse!) but it can take a while. I can't just give up after 6 days after an infection - that seems crazy. We look after him almost 20 hours a day and constantly checking on him, feeding, changing the towels, giving medicine, etc. I want to at least try!

It was the nurse that the message was passed onto again from the receptionist.. but I got a vet calling me an hour + from now and maybe they'll understand better. If not, I'll have to go private and to a rabbit specialist.

I am concerned about side effects from antibiotics, but I feel it might be worth the risk in this case since there is no definite test or diagnoses of the parasite causing the symptoms. I know the quinolone antibiotic baytril that is frequently prescribed can also cause nervous system damage (my achilles tendons and peripheral nerves were damaged from taking Cipro a long time ago). So that on top of a possible parasite CNS issue might make that issue worse IF it's not an ear infection.

It's tough decision tbh, but trying to weigh up the risks here.

I've done a lot of research and found a couple of natural compounds that are helpful in pasteurella infections in RABBITS, and I'm currently giving him them to lessen tissue damage and fight infection (started on day 1). They also make antibiotics more effective and reduce MIC.

- Allicin 50 mg/kg
- Yeast Beta Glucan - 50 mg/kg

But why are the vets wanting to be so hasty in wanting to put the rabbit to sleep? He has improved in many ways since last week already, it's just his balance and head tilt right now. I get the feeling that they don't even give rabbits in this position a chance to survive, like many people no here have done. So maybe they don't see recoveries. But I've certainly seen enough examples now of rabbits that were worse than mine and make decent recovery.

My parents are both COVID positive and I got sick for a day, too. So the issue here now is that I can't even take him to a private vet... at least until the 4th November.

Am I making the right decision?

Who is right here? Am I making the right decision in trying to get the vets to cover a bacterial infection and help treat inflammation? Am I right in giving him a chance? He gets almost 24 hour care. I heard it can get worse before it gets better, is this really true?

Thank you in advance for any responses...

References:

1. Peripheral or Central Vestibular Disease: Yes, It Matters
https://www.vin.com/apputil/content/defaultadv1.aspx?pId=11349&catId=34765&id=5328290

2. Alternative treatment of serious and mild Pasteurella multocida infection in New Zealand White rabbits
https://bmcvetres.biomedcentral.com/articles/10.1186/s12917-014-0276-6

3. Anti-Inflammatory, Immunomodulatory, and AntioxidantActivities of Allicin, Norfloxacin, or Their Combination against Pasteurella multocida Infection in Male New Zealand Rabbits
https://www.researchgate.net/public...ltocida_Infection_in_Male_New_Zealand_Rabbits

IMO it is perfectly reasonable to request antibiotics and a NSAID as well as the Panacur in the absence of a definitive diagnosis of EC . A PCR blood test is needed to confirm EC. A n anti motion sickness medication can also be given to try to reduce the dizziness and rolling- ie Meclizine or Prochlorperazine .

The PDSA probably have a set criteria for how far they can go with regards to treatment given that they are a Charity and clients only pay a minimal amount. You would probably get more advanced treatment at a Specialist Practice. That said, providing antibiotics and a NSAID is not a big ask , especially when 1- a definitive diagnosis has not been established and 2 the only alternative offered is PTS

If you are on Facebook I ‘d suggest joining this group

https://www.facebook.com/groups/HelpforHeadTiltHoppers/

It might be possible for you to get a consultation with a private vet over the phone. If you register your rabbit with them and have the notes transferred from the PDSA that may save the need for an initial face-to-face consultation - you would just be asking for a follow up, and given the Covid situation, that might happen by phone regardless... if not then just explain that you are self-isolating.

You clearly have an excellent understanding of what is required, causes, effects etc and if you can get a knowledgeable vet to speak to you (shouldn't be a problem if you find the right one) then I think it's highly likely you could get them to prescribe antibiotic and anti-inflammatory. (Some vets will post these medications to you)

You are absolutely doing the right thing treating your rabbit rather than giving up so early, especially as there have been good signs of progress so far.

I am sorry your bunny is unwell but I do know that rabbits can recover from EC. It takes a while and most Vets prescribe Panacur, Baytril and Metacam, a few seem to think PTS is the answer! Can you get some Metacam on line to help reduce any swelling. Maybe you need to look for a Rabbit savvy vet. The RWA have a list of Vets. The website IM has suggested is very good, and I hope bunny will start to recover in time.

tonibun said:

I am sorry your bunny is unwell but I do know that rabbits can recover from EC. It takes a while and most Vets prescribe Panacur, Baytril and Metacam, a few seem to think PTS is the answer! Can you get some Metacam on line to help reduce any swelling. Maybe you need to look for a Rabbit savvy vet. The RWA have a list of Vets. The website IM has suggested is very good, and I hope bunny will start to recover in time.

Click to expand...

You would still need a prescription from a vet to buy Metacam on line as it is a prescription-only-medication.

I agree with all the above. It is a common condition in rabbits, and often with no confirmed diagnosis. Treatment is fairly standard to deal with both EC and ear infection. So I would expect antibiotics (eg Baytril, in case of inner ear infection), Panacur (to treat for the EC parasite) and an NSAID (eg Metacam, for pain relief and anti-inflammatory for both options). For EC, the NSAID is important to reduce the neurological symptoms and damage caused by the parasite. None of them are expensive or unusual medications. All can be given orally at home.

EC is a rollercoaster ride. The standard course is 28 days of Panacur - treating all rabbits who share the same space. The parasite is shed in the urine, so it is important to maintain hygiene. Disinfection on days 21 and 28 of the treatment will break the cycle of reinfection (so 10% bleach solution or steam clean everything, and dispose of hay, wash towels, etc).

10% liquid Panacur (for cats & dogs) can be obtained online without prescription so you can treat all the rabbits with the correct dose, depending on their weight.

Try another vet and explain what's happening. Maybe take a video of your poorly rabbit so they can see the symptoms. The notes from the PDSA shoud be transferrable. This won't be a unique situation for them to dea with.

I suspect the PDSA branch doesn't treat many rabbits, so PTS was their go-to recommendation. Rabbits cope quite well with EC if they have good nursing to meet their needs, and should recover. Other possible causes need to be addressed as well - so ask for the antibiotics as well, in case of an ear issue. Give it a few weeks and you should see a difference. Make sure your rabbit is eating propery - you may have to supplement with liquid feed (use your normal pellets mushed up, with a bit of apple, banana or carrot puree)

Sorry you're having difficulties with your rabbits health. Personally I'd be more focussed on getting metacam & less worried about the antibiotics, as a young (& presumably agile before this) bunny with uppy ears he'll be loads less likely to have an ear infection than a lop would. My EC bun had horizontal nystagmus, moving quickly to severe head tilt & rolling. I don't think you're wrong to give up on your bunny, I'm glad I didn't give up on mine.

I would push for antibiotics and NSAIDS. Several bunnies of mine recovered with those items and supportive care.

Thanks for the advice, encouragement and giving me a bit of hope here...

I can't believe I never heard of this condition before until now and we've had many rabbits over 30 years. This time my sister got two dwarf rabbits from a rabbit breeder - who apparently has a lot of them. So if it's EC, maybe the two that we got from her were already infected. I'll be starting the others on Panacur as well on the weekend anyway.

It's distressing to see him constantly rolling and unable to stand on his feet. But it's still less than one week since he has been like this, so it's very early days yet. It struck so fast... just hours before I put him in for bed and he seemed completely fine. The initial improvement made me think, well, this must be EC, it seems panacur was working after 2-3 days. It was the 4th day I think that the rolling got very bad.

The rolling is the most difficult thing to deal with right now. Hoping that he won't hurt himself. But we have towels and as much padding as we can. I guess I can only do so much here.

We check up on him frequently, aside from the regular feeding, medicine, and cleaning. I work from home and my parents are here, too, so there's always someone around.

The easiest part so far has been feeding him. Fortunately, he still loves food and seems to really enjoy Critical Care that we're giving him! When we're feeding him, as long as he's supported correctly, he's super calm. His appetite seems very good.

Right now he seems stable and not worsening in any other way. It's only the head tilt and rolling being the main symptoms. I've read about head tilt often getting worse before it gets better, so I'm hoping for even a little bit of improvement within a month or so. Even if it didn't resolve completely, it seems a lot of rabbits can adjust in time.

I'll be getting a second opinion from Valley Vets in Cardiff with regards to his treatment. The PDSA recommended that I go there.

I'll make sure that I keep this thread updated so others can learn from this experience as well...

Thanks all... I appreciate it!

It is so distressing seeing them roll Its great to hear he has such a good appetite.

My bun started making significant progress about 5 weeks in (ie she was back on her feet). She did have one little relapse but it was less severe & over in a few days (on vets advice we recommenced panacur & metacam). She lived 2 more happy years & died at 8 years.

I hope the next vets app goes well. My vet always recommended panacur at times of predicted stress (house moves, bonding etc) - I reckon this is a good thing to discuss at your app. As you'll know by know EC is thought to be 'activated' at times of physical stress / illness & emotional distress. The bun I spoke of above became really poorly within 24 hours of losing her bonded sister

Thank you, Joey&boo... appreciate your responses. I'll keep that in mind for the future for all my rabbits if stressed... especially Thunder. I've added Beta-Glucan (a well studied water-soluble polysaccharide), as that has been found to be a very good immune system modulator in various animals and humans. There's a lot of research on it, one study showing that it improves the health status of rabbits, and regulates inflammation response, improves endogenous antioxidants, glutathione, SOD2, and catalase; and improves how fast the immune system reacts and deals with antigens. Even improving immunity when animals are stressed.

I'm starting to think the vet might actually be right with the initial diagnoses. I've been doing a lot of research on the parasite and its effects. One of the most clear signs Thunder has right now is issues with proprioception. Basically, it seems that he doesn't know where his feet are and so he can't right himself and stand. So he's just rolling and lying down. This is more typically seen with brain stem issues and E.cuniculi.

I have noticed today that when I am putting my hand near him when he's lying down, he was sometimes pushing my hand away with his front paw. This might be a good sign as he is becoming aware of limb position to do that. For the few days, that was absent.

Otherwise he seems in good spirits today, despite the rolling.

I captured a video to show how the rolling is on day 9. He still seems stable in other ways, not getting worse and no new symptoms. Still just the rolling and not being able to right himself.

*Admin edit - video may be distressing to some people

Sending positive thoughts.

Poor little fella I would advise that you find a Vet willing to prescribe meclizine or prochlorperazine which may lessen the dizziness and rolling. I assume that he is still on Fenbendazole ? Did the PDSA agree to antibiotics and Metacam in the end ? I would definitely want these to be prescribed pdq in the absence of a definitive diagnosis. I hope that the Vet in Cardiff can help x

lots of well wishes for your vet app. Travel is really disorientating for them at this stage. If you can get someone to hold him securely for the travel to vet trip that might help.
Its pretty amazing they can come back from these symptoms but they can & do

OMG! He's standing!!! First bit of progress for a few days!

Yes, he's still on Panacur (10 days so far).

Also treating him with Yeast Beta Glucan 50 mg / day and Allicin Max (stabalized allicin) 50 mg/ day.

Sending lots of vibes for him :wave:

Wonderful, I really hope that the improvement continues

Lovely update to hear he is standing.

Thanks all!

Day 11

This morning he seemed a bit tired and lethargic, but still had all of his food when offered to him. I checked to see if he was going poo and peeing and everything there seems normal. I think he might've just been a bit tired or maybe he needed more water. He perked up this afternoon and seems to be fine now.

He stood up about 5 times today so far, but each time it was only for between 10 - 60 seconds at a time. When I offered him a bit of bell pepper, he flipped over and landed on his feet to eat it.

Even though he is only standing for a few seconds at a time, I believe this could be important sign of improvement - especially considering the last time he was able to stand up for any period of time was on day 3. From day 4 to 9, he couldn't get on his feet and would roll a lot.

I've noticed far less rolling today and he seems to be more calm.