4 weeks in with EC! Please help me understand a few things!

I'm going to start at the beginning - towards the end of May me and my fiancé came home one Sunday evening and noticed one of our buns Bibi greeted us with a ever so slight head tilt...and a tiny bit slower, with the head swaying slowly towards the ground, we both got paralized with fear because have read horror stories about EC so immediately took her to our trusted exotic vet (we live in UK)... we did blood tests on the spot and were given Panacur and antibiotic (enrofloxacin) just in case it's a ear infection... around day 3 there was no sign of head tilt and Bibi was back to her usual self, once we got the blood work done, the vet said its not EC but most likely an ear infection but nothing serious since she had her ear checked thoroughly and sample taken just in case it was mites... we've been given ear drops that she hated and the moment blood tests came back we were told to stop panacur and antibiotics. (in hindsight maybe we shouldn't... )She was taking them for 5 days.
In 4 weeks time we did another blood test to confirm it's not EC and nothing showed...

Then, out of nowhere, without a warning on 20th of July, we came home around 5 pm, she greeted us as usual, 'twisting our arms' to give her nuggets and fresh round of dried greens that we are ordering every month for them, she munched on the nuggets and around 6 pm she was still active and playful. Then, after 7pm I looked under the bed to see what the little ones are doing, and saw Bibi with the biggest flop of her life but with head tilted unnaturally... still I thought she was sleeping so I petted her and she wasn't reacting and had her eye wide open, since our vet was already closed we immediately called out of hours vet and took her in... she was given a shot of antibiotics... the next morning we book an emergency appointment with our vet and yet again we did blood test, was told to continue with the antibiotics for now and were given Panacur just in case. The initial blood test came back with anemia (red blood cell count under 18% and in following weeks going as low as 13%...) and possible renal disease... so we kept her with IV fluids for a week at the vet... keep checking the blood parameters.
She couldn't stand up but for the first two days she was breathing calmly... and after that she started breathing very very fast. Now... we did 2 x-rays, first of the head, which didn't show potential inner ear infection, and second one of the body and that one showed potential kidney stone as well! ( (on the right side to which her head is swaying' -> emphasis on SWAYING, as it is not a traditional head tilt... ) which will mean operation to remove that kidney and that in and of itself its a tremendous risk that is IF we will be able to fight off EC (which was confirmed 10 days later after the first blood test...) Since then we kept checking her blood parameters and finally last week her blood red cells count started to climb, and we were told she had a strong regenerative response... We were so happy that this is finally a sign of slow but gradual improvement, she also started to manage to pick herself up and stand on her own but it's obvious how weak she still is... we have another appointment tomorrow with regular weighing and blood tests. 2 days ago was our happiest because she was getting up a lot more and even started kissing my nose and face when I leaned over to give her usual kisses... (( I nearly cried... and yesterday we have noticed she is a lot weaker again, and not so keen on eating (I should have said before that ever since it happened we have been giving her critical care for fiber but she hasn't lost her appetite and she was pooping and peeing fine (we did have to hand feed her every leaf of greens but she was keen on eating still -> I took first week off work to stay with her and after that my fiancé was coming home during work hours to check on her... but yesterday we have noticed possible slight urine scald even though we are cleaning her very thoroughly with luke warm water and drying her afterwards as best as we can.. on top of that ever since she left the daily vet care with we've been giving her 100 ml sub q fluids every 12 hours to help out with that one tiny kidney... (( and tramadol every 8 hours half a tablet for painrelief since we were told Metacam might be too overwhelming if she is presenting kindey issues.. its suffice to say that we have spent a little fortune already on the vet bills and we are running on fumes but we both will do absolutely everything we can to help her for as long as she is willing to fight with us.. I have literally tears in my eyes as I am typing this, we both love her so much and she is our little baby, she is only 2... I really apologize for such a long post but I wanted to include everything in it... I'm is trying to find as much information as possible and we really rely on people here to maybe give us some reassurance and hope? Tell me there is still time for her to get better and the fact that it has been 4 weeks today it still may very well take longer for the recovery... ;((( I know we need to think of quality of life etc. and we are aware of this but right now we need to do everything we can to try and help her... today also marks 28 day of Panacur, our vet told us that he has seen rabbits being on Panacur for 3 months, before he's taken them off of it and they eventually got better, I am also aware that sometimes the neurological issues may resolve themselves in a span of a year according to one success story... and we don't mind the head tilt as long as she is happy ( Should add that her hind legs are very weak, one on the side of ill kidney... and I think they might be a bit swollen?? She is not so keen on eating today as well... we both are devastated ((

Anyone with similar experiences please can you offer some words of wisdom and help perhaps? (

Thank you so much in advance...

So sorry that your Rabbit is very sick. Unfortunately if her kidneys are damaged then this cannot be cured, but there are some medications which can help slow the progression of renal failure, eg Benazapril. As you might know, EC can cause renal failure and if she also has kidney stones this will compound the problem. I think the head tilt/swaying is the least of the problems associated with EC.

The weakness you mention could be due to muscle wastage, the result of being relatively immobile and a direct result of renal failure. Anabolic Steroids can help reduce the rate of muscle wastage caused by renal failure, anabolic steroids also boost the appetite.

Anaemia is a common finding in cases of renal failure. Erythropoietin can be a useful supportive treatment.

It sounds as though you are looking at supportive treatments to give the best QOL for as long as possible as opposed to the possibility of an complete cure. Hopefully you have a trusting relationship with your Vet and they will give you a realistic prognosis.

Thank you... and thank you for such a swift reply, Yes I know we are looking at removing that kidney which already our vet has consulted specialist clinic in London and they have recently performed this procedure and the bunny feels fine... but that was supposed to happen after EC is under control...
Also I appreciate names of those meds I will ask my vet tomorrow if I can have them, he also is strongly opposed giving her steroids which I have already asked about as well..
"It sounds as though you are looking at supportive treatments to give the best QOL for as long as possible as opposed to the possibility of an complete cure." - > I know that potentially I am staring down the barrel of future EC flare ups and I also found a few articles (just a handful really) with bunnies living happy lives with one kidney... and I do realize that there is A LOT of hopium in thinking this... are you saying that the outlook is rather grim at this point? ;(

Oskar said:

Thank you... and thank you for such a swift reply, Yes I know we are looking at removing that kidney which already our vet has consulted specialist clinic in London and they have recently performed this procedure and the bunny feels fine... but that was supposed to happen after EC is under control...
Also I appreciate names of those meds I will ask my vet tomorrow if I can have them, he also is strongly opposed giving her steroids which I have already asked about as well..
"It sounds as though you are looking at supportive treatments to give the best QOL for as long as possible as opposed to the possibility of an complete cure." - > I know that potentially I am staring down the barrel of future EC flare ups and I also found a few articles (just a handful really) with bunnies living happy lives with one kidney... and I do realize that there is A LOT of hopium in thinking this... are you saying that the outlook is rather grim at this point? ;(

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I am referring to ANABOLIC steroids, not Corticosteroids.

I am not at Vet, but IME the situation you describe would carry a very guarded prognosis.

I understand, I will ask about the anabolic steroids again as well as other two you mentioned, If there are any success stories from other members on this forum they would be most welcome...

And once again thank you for you help...

Oskar said:

I understand, I will ask about the anabolic steroids again as well as other two you mentioned, If there are any success stories from other members on this forum they would be most welcome...

And once again thank you for you help...

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Anabolic Steroids are very different to Corticosteroids, the use of latter is usually contraindicated for Rabbits due to the fact that Rabbits are very sensitive to the potential adverse side effects, especially suppression of the immune system.

With regards to kidney removal due to renal stones, this can be done, but not if the remaining kidney has sustained damage from EC. So the Vet would have to consider this fact very carefully.

InspectorMorse said:

Anabolic Steroids are very different to Corticosteroids, the use of latter is usually contraindicated for Rabbits due to the fact that Rabbits are very sensitive to the potential adverse side effects, especially suppression of the immune system.

With regards to kidney removal due to renal stones, this can be done, but not if the remaining kidney has sustained damage from EC. So the Vet would have to consider this fact very carefully.

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Exactly that... and I was told that there is no real way of finding out if the second kidney is fully functional without another procedure under anesthesia?

And If that's the case could she be able to live with those kidney stones and some supportive medication? Or would that be too painful for her...? We also don't know how long ago those stones have formed and she was happy playful and active up until 4 weeks ago with no signs whatsoever of any problems, I do understand that Rabbits are hiding their conditions well but we are trying to be REALLY vigilant knowing how fragile they are

Oskar said:

Exactly that... and I was told that there is no real way of finding out if the second kidney is fully functional without another procedure under anesthesia?

And If that's the case could she be able to live with those kidney stones and some supportive medication? Or would that be too painful for her...? We also don't know how long ago those stones have formed and she was happy playful and active up until 4 weeks ago with no signs whatsoever of any problems, I do understand that Rabbits are hiding their conditions well but we are trying to be REALLY vigilant knowing how fragile they are

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It is hard to give an exact account of how likely it is that a Rabbit could manage with renal stones. Problems occur if the stones move and obstruct the Ureter. Also, recurrent episodes of infections/pyelonephritis are likely. These would cause pain which in Rabbits leads to anorexia and gut stasis. But it could be possible for the stones not to cause too much trouble, initially at least.

Not sure if you have already seen this information

*WARNING LINK CONTAINS GRAPHIC IMAGES*

http://www.medirabbit.com/EN/Uro_gen_diseases/Mech_diseases/Urolithiasis.htm

I have just read through that so thank you for this,

We have cut back on antibiotics to once a day now for about a week (as advised by the vet) what should I think about those swollen back legs? Could I give her second dose of those antibiotics tonight as I have for the first three weeks on the off chance that urine scald could be causing a minor infection? Or am I grasping straws at this point? And I'm sorry If I'm being a pain with all these questions, I really appreciate you taking time to respond to them patiently ...

Please dont feel that you are being a pain asking lots of questions. The answers will help anyone in a similar situation and can be educational for all of us.

Oskar said:

I have just read through that so thank you for this,

We have cut back on antibiotics to once a day now for about a week (as advised by the vet) what should I think about those swollen back legs? Could I give her second dose of those antibiotics tonight as I have for the first three weeks on the off chance that urine scald could be causing a minor infection? Or am I grasping straws at this point? And I'm sorry If I'm being a pain with all these questions, I really appreciate you taking time to respond to them patiently ...

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If the Vet advised the antibiotic dose reduction then I am not qualified to advise you to do otherwise. Without being able to see her legs it is hard to know if the what you are seeing is inflamed skin or oedema (fluid build up). The latter being possible with renal failure.

She stopped breathing last night around 10.30pm. Her back legs were swollen and 3 hours prior I have given her 100ml of subcut fluids. It looked like she had tremors, with her head slightly moving forward, then panickily she started to crawl forward in a circle not being able to stand up, and desperately gasping for air with her mouth open as if she was drowning. Then few seconds later she died in my arms. The whole thing happened in a span of 20 seconds maybe, if I can trust my foggy brain.
Entire evening I sat beside her petting her and she seemed calm and was breathing peacefully.
I will see the vet in an hour, will ask for necropsy, I need to understand what I did wrong or if I could do more.

I have never been in so much pain in my life.

Thank you for your answers.

So sorry. RIP Bibi

I'm so sorry for your heartbreaking loss. It won't have been anything you did. I hope you find answers through the post mortem

Sweet dreams Bibi

Oskar said:

She stopped breathing last night around 10.30pm. Her back legs were swollen and 3 hours prior I have given her 100ml of subcut fluids. It looked like she had tremors, with her head slightly moving forward, then panickily she started to crawl forward in a circle not being able to stand up, and desperately gasping for air with her mouth open as if she was drowning. Then few seconds later she died in my arms. The whole thing happened in a span of 20 seconds maybe, if I can trust my foggy brain.
Entire evening I sat beside her petting her and she seemed calm and was breathing peacefully.
I will see the vet in an hour, will ask for necropsy, I need to understand what I did wrong or if I could do more.

I have never been in so much pain in my life.

Thank you for your answers.

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So very sorry. I suspect that she was in renal failure and heart failure

RIP Bunny x