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E cuniculi — can you give me some hope?

The Goose

New Kit
Hi, everyone! My dear rabbit Leila (code name “The Goose”) is fighting E. cuniculi.

Leila first showed symptoms last September (wobbliness; loss of appetite; wouldn’t drink) but recovered on her own within two weeks, before we could figure out what was wrong. She had another flare last December, and again the vets were stumped and the symptoms receded on their own.

In late February Leila’s health dived again. It’s been so much worse this time. She’s lost all mobility in her hind legs. She can’t sit up or groom herself, and though she’ll still eat fresh greens and Oxbow supplement treats (yay!) she won’t eat hay or drink water (not even fruit-flavored water or banana-water smoothies). Here's some more details on her symptoms and treatment regimen if anyone's interested.

I’ve been to five vets in the past few month. I know most rabbits carry EC asymptomatically, so a definitive diagnosis isn’t a realistic expectation. I also understand that x-rays won’t pick up on everything. That said—when we finally did get a titer test, Leila was a “strong positive” for EC. She’s gotten two x-rays in the past five months with no sign of spinal injuries, though she does struggle with recurring gas and some bladder sludge (poor baby).

I’m hoping a couple of you might have EC success stories to share?? It’s been nearly a month and a half of hind leg paresis now, and we’ve just started our second round of Panacur (+Metacam, an antibiotic, a gut motility drug, and occasional Gabapentin). I’m terrified Leila’s never gonna regain the use of her hind legs. For those of you who’ve pushed through EC with limb weakness, how long did it take before your rabbit was able to sit up by themselves again?? Some people online say any nerve issues are often permanent, and others say they’ve never seen a case where an EC rabbit’s legs stayed limp forever. Leila’s my whole world; I’m stressed out of my mind and barely sleeping, and I’m desperate for some hope.
 
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I've had a couple of rabbits with EC over the years. One was a fairly standard case and needed treatment (panacur & metacam daily for 28 days) maybe a couple of months every year when symptoms recurred. The signs were very subtle if caught early on and responded well to treatment. There were no long term disabilities.

My first case was very severe. She came in from the garden one day as usual and had collapsed by the time she reached the kitchen. She was out of action for months. It was very much a rollercoaster ride. She had her head twisted and fixed right round to her shoulder and had no use in her back legs. She had to be hand / syringe fed and her bum cleaned for several months until she was able to do things for herself. Often there were huge backwards steps with little progress between. At about 10 months on, she was back outside in her run and you couldn't tell there had been anything wrong. She wasn't able to jump up onto things, but that was all that was wrong long term, plus a slight head tilt. I don't recall her having any further attacks, but it was many years ago and my memory has got a bit hazy.

Recovery is usually good if treatment is maintained and any additional care needs provided. The parasite is excreted in urine, so it is important to regularly disinfect or steam clean anything that has come into contact with urine. Days 21 an 28 of the treatment cycle are the critical cleaning days (tied in to the lifecycle of the parasite), but I did it weekly. Any other rabbit in the same space needs to be treated with Panacur at the same time. Treatment doesn't completely eliminate EC, but it does reduce the parasitic loading. Retreat with the 28 day treatment and cleaning cycle(s) if any symptoms recur. Stress of any sort (illness, a change of environment, new rabbits, etc) is a common cause of reactivating an EC infection in a susceptible rabbit.

Metacam is used as it reduces the symptoms / damage caused by the parasite, so it is important to use it along with Panacur in an infected rabbit.

Suitable disinfectant regimes include use of a 10% bleach solution, Virkon S or steam cleaning - depending on the items being cleaned.

My advice is just to keep going - for as many consecutive treatment cycles as it takes, and provide for any additional daily needs. I kept a diary so I could follow the changes week by week when it seemed that things were not improving, and it was useful to look back on to show the progress we had made.
 
Apologies that my response will be in bullet point formation

1- QOL must always take priority when assessing how long to keep trying to treat EC when symptoms are so severe. If the Rabbit is distressed by all the essential hands on care then as it is likely to be needed for months IMO it is unethical to continue treatment
If the Rabbits copes well with handling, is showing interest in their surroundings, is eating at least a little for themselves and not fighting syringe feeds, is not urine scalding and is presenting as ‘happy’ then keeping going for longer is, IMO, an option. Only you can judge the QOL of Leila. Prolonged treatment is fine for some Rabbits but for some it’s just too much and it is kinder to let them go.

2- Renal function needs to be assessed (blood test) as EC can destroy the kidneys. This is irreversible and will result in renal failure. IMO assessing renal function plays a significant part in my decision making process of carrying on with aggressive treatment or not.

3 - Muscle mass is lost rapidly when the hind legs are paralysed. Once spinal fractures are ruled out a physiotherapy regime is essential for any hope of regaining some use of hind legs. EC damage to the CNS might be permanent though, which only time will tell. The longer the paralysis goes on the less likely it is that the Rabbit will regain any use of the affected limbs. Regular neurological response checks should be carried out to ascertain if any progress is being made. I have not seen a Rabbit recover use of their hind legs if paralysis has been a symptom that has not improved at all for more than 8-10 weeks.

4- Manual bladder expression is often needed with cases of hind leg paralysis. The Rabbit may lose bladder sensation/control. This leads to the retention of urine, build up of calcium deposits, bladder sludge/stones, renal stones. It also exacerbates EC induced renal damage. DO NOT attempt to do this yourself until you have been taught how to do so safely by a Rabbit Savvy Vet. The bladder is very delicate and can easily rupture.

5 - Being so disabled is going to put Leila at high risk of Flystrike, even if kept indoors. Vigilance is needed to avoid this


6 - Rabbits with hind leg paralysis are very prone to ear infections. Their lack of ability to self groom leads to ‘gunky ears’ which can then become infected. Regular (daily) ear checks with a otoscope are essential. Ear cleaning is something else a Rabbit savvy Vet needs to show you how to do safely and what products to use to do the job. You can buy a basic otoscope for a reasonable price. A Rabbit savvy Vet can instruct you about examining the ear canals daily.

7- pododermatitis and urine scald are two more possible problems that can occur due to hind leg paralysis

8 links which might be useful to read











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