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

[dex179]

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.

The vet didn't mention Chloramphenicol - would you advise I mention it to them? I wouldn't want to take it if it wasn't prescribed but I guess if they're not rabbit savvy they may not mention it?

Thank you for the advice for cleaning the eye - I've been wiping his eyes with warm boiled water and cotton pad, but I will hold it against his eye a it longer. He pushes against my hand when I do this but he's not overly fussed

Thank you for all your advice. I'm going to push on for a little longer and see what I can do.

 

[Omi]

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



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?

It's difficult to judge your current vets without actually taking part in the discussion with them and so it would be unfair to criticise. There are a couple of things though that would make me wonder how experienced they are in treating rabbits. One would be to determine it's unlikely to be EC because it hasn't cleared up after 6 weeks' treatment. Many members of this forum have cared for rabbits with EC for a lot longer than that before seeing improvement. Another would be to advise stopping the Panacur after 6 weeks. I would also query the conclusion that it's not EC, nor ear infection, but something wrong with his brain, which to me doesn't seem to be based on any evidence and in my view doesn't square with him improving, albeit slightly.

However, getting a second opinion is, I think, very reasonable, especially as your vets seem to often talk about QOL. It's something that in your position I would want to do, especially as you have a rabbit friendly vet close to you. You are perfectly entitled to request a second opinion, but you would need to let your current vet know. I would actually say to them that it's because of the QOL question, you would rather get a second opinion before coming to any decisions, rather than querying their treatment.

Getting up and lying down again does sound like improvement.

 

[InspectorMorse]

If the PCR blood test for EC has shown very low titres/ not EC then personally I would NOT keep going with Fenbendazole ( Panacur). Whilst the drug is generally safe when given in cases where- by it is clinically proved to be necessary, like all drugs it isn’t without side effects. Especially with longterm use. One being the possible suppression of bone marrow production which can impact on the immune system.

An Update on the Biologic Effects of Fenbendazole - PMC

Fenbendazole remains the drug of choice to treat pinworm infection in laboratory rodents. When fenbendazole was last reviewed (15 y ago), the literature supported the drug’s lack of toxic effects at therapeutic levels, yet various demonstrated ...

www.ncbi.nlm.nih.gov

What antibiotic is he now on ? Azithromycin or Depocillin ( BY INJECTION ONLY) can be useful for the treatment of otitis media. Although they might not be curative they can contain the infection. Sadly otitis media is a very problematic condition to treat and often involves major surgical intervention. Not something to be entered into lightly, especially when the Rabbit is elderly and/or has other co-morbidities.

https://www.vettimes.co.uk/app/uploads/wp-post-to-pdf-enhanced-cache/1/diagnosis-of-otitis-externa-media-and-interna-in-rabbits.pdf

https://capello.vet/assets/surgical-treatment-of-otitis-externa-and-media-in-pet-rabbits.pdf

https://www.pure.ed.ac.uk/ws/portalfiles/portal/342918894/In_Practice_Review_Article_Accepted_in_press.pdf

Medirabbit

Any brain involvement due to bacterial infection or EC is likely to cause nystagmus and very probably seizures. Whilst the absence of either of these two symptoms can’t confirm that the brain is not affected it makes it less likely.

Is he losing weight ?

You have every right to seek a second opinion from a different Vet and if you know of a local Rabbit Savvy Vet you could do that. Informing them of the fact it’s a second opinion you are seeking. They will request your Rabbits clinical records from your current Vet. So personally out of courtesy I would tell the current Vet that you want a second opinion. The second opinion Vet *might* only see unregistered new patients if done as a referral from a Vet for a second opinion anyway. At the moment many Practices are not accepting new clients who are already registered with a local practice.

Whilst it is very possible that your Rabbit cannot be cured it is possible for him to be kept comfortable enough to have a reasonable QOL, remaining on longterm medication and daily nursing care.

http://www.disabledrabbits.com/head-tilt.html

http://www.disabledrabbits.com/quality-of-life.html

Quality of Life Scale for Pets online calculator

JOURNEYS Quality of Life Scale calculator helps evaluate the difficult decision for your failing pet. "Is it Time?" - call to discuss your situation.

journeyspet.com

 

[Orenoko]

The vet didn't mention Chloramphenicol - would you advise I mention it to them? I wouldn't want to take it if it wasn't prescribed but I guess if they're not rabbit savvy they may not mention it?

Thank you for the advice for cleaning the eye - I've been wiping his eyes with warm boiled water and cotton pad, but I will hold it against his eye a it longer. He pushes against my hand when I do this but he's not overly fussed

Thank you for all your advice. I'm going to push on for a little longer and see what I can do.

It could be worth mentioning definitely, but if they agree with using it try and get it online instead as it'll be much cheaper! I'd also agree with Omi re a potential second opinion as head tilt bunnies really can take a long time to improve and I wouldn't want you to make a decision prematurely.

 

[bunny momma]

I had several head tilt bunnies and their outcome has ranged from complete cure to some residual tilt, to progressive disability.
It is unlikely Dexter got ill because you took a well deserved vacation.
It can be difficult to assess a bunny who is ill when you see them daily, especially when symptoms vary from day to.day. It may help to take short videos to compare progress every week or two.
You know your bunny best, so only you can assess Dexter's demeanor. Also, if there are small improvements and the rabbit is eating and otherwise comfortable, I see no harm in giving him more time with his loving family.
I started to use reusable puppy pads with my Raven.
.

 

[dex179]

Morning All

Thank you for your advice

@InspectorMorse - yes the blood test did come back to say that there were low levels of the EC bacteria. I did request a second course of panacur as the vet doesn't think there will be any problems continuing, but you are correct - there will always be side effects.

Because of a tooth abscess problem, I've actually been giving him a daily injection of depocillin every day for 4 years! So good to know that this also could help with possible otisis media

Regarding seizures - no he doesn;t have any. He did have nystagmus to start with but the vets have confirmed that this has cleared up. So potentially it may not be a problem with the brain?

@Omi - I don't think they are extremely experienced with rabbits but I've just built up loyalty with them and to be fair they always do their best. I think you make a fair point that because my vets have discussed quality of life, I should get a second opinion. So thank you for this advice.

I guess the vets said it most likely isn't EC just because the blood test came back negative for EC and we've been on EC treatment for 6 weeks. I do appreciate the comments from everyone saying that it may be worth while continuing for longer and the vets have said they don't think there's any problem continuing - they just say it probably won't help.

@bunny momma - thank you for the advice with the puppy pads, I'll look into that one. Right now I'm doing a combination of fleece blankets and then vet fleece on top, so far it's keeping him dry.

Update on Dexter's condition: I've made his space a bit wider and he's actually getting up and moving towards his food. Seems slightly more active than a few days ago, although yesterday morning I had a scare as it looked like he hadn't eaten overnight, so had to work from home in the morning to nurse him back. I'm just glad he's actually getting up and finding his food, and then after eating chilling flat out! His head/body tilt seems the same though.

 

[InspectorMorse]

Morning All

Thank you for your advice

@InspectorMorse - yes the blood test did come back to say that there were low levels of the EC bacteria. I did request a second course of panacur as the vet doesn't think there will be any problems continuing, but you are correct - there will always be side effects.

Because of a tooth abscess problem, I've actually been giving him a daily injection of depocillin every day for 4 years! So good to know that this also could help with possible otisis media

Regarding seizures - no he doesn;t have any. He did have nystagmus to start with but the vets have confirmed that this has cleared up. So potentially it may not be a problem with the brain?

@Omi - I don't think they are extremely experienced with rabbits but I've just built up loyalty with them and to be fair they always do their best. I think you make a fair point that because my vets have discussed quality of life, I should get a second opinion. So thank you for this advice.

I guess the vets said it most likely isn't EC just because the blood test came back negative for EC and we've been on EC treatment for 6 weeks. I do appreciate the comments from everyone saying that it may be worth while continuing for longer and the vets have said they don't think there's any problem continuing - they just say it probably won't help.

@bunny momma - thank you for the advice with the puppy pads, I'll look into that one. Right now I'm doing a combination of fleece blankets and then vet fleece on top, so far it's keeping him dry.

Update on Dexter's condition: I've made his space a bit wider and he's actually getting up and moving towards his food. Seems slightly more active than a few days ago, although yesterday morning I had a scare as it looked like he hadn't eaten overnight, so had to work from home in the morning to nurse him back. I'm just glad he's actually getting up and finding his food, and then after eating chilling flat out! His head/body tilt seems the same though.

It could be that Depocillin won’t be of use if your Rabbit has been on it for years. Resistance to Depocillin could be an issue now. Has the Vet taken a recent blood profile to check infection markers ? Dental abscesses can eventually become a more systemic infection as the disease progresses. Hence other bacterial infection can result eg ear infections, respiratory tract infections, spontaneous abscesses at other sites. If the tooth roots are elongated, which is one of the primary causes of tooth root abscesses, then progression of tooth root elongation can lead to the roots penetrating the middle/inner ear and even the brain. Abscesses then forming at these sites.

Is your Rabbit having physiotherapy ?

 

[dex179]

It could be that Depocillin won’t be of use if your Rabbit has been on it for years. Resistance to Depocillin could be an issue now. Has the Vet taken a recent blood profile to check infection markers ? Dental abscesses can eventually become a more systemic infection as the disease progresses. Hence other bacterial infection can result eg ear infections, respiratory tract infections, spontaneous abscesses at other sites. If the tooth roots are elongated, which is one of the primary causes of tooth root abscesses, then progression of tooth root elongation can lead to the roots penetrating the middle/inner ear and even the brain. Abscesses then forming at these sites.

Is your Rabbit having physiotherapy ?

I did pose the question to my vets recently, whether it was worth continuing with depocillin given that he;s been on it for ages. They said might as well carry on, which is the safest answer to give. I remember quite early on when he first started the depocillin, and as soon as we took him off it, the abscess came back. Which is the rationale as to why we've continued with it, to this day

We did have a recent blood test (is that what you mean by blood profile?), which was the one that indicated a low count of EC bacteria. I'm not sure if they checked anything else? Your logic does make sense in terms of the impact of elongated roots. He had nearly half of his teeth taken out about a year back...and somehow still bounced back from that!

I've never thought about physiotherapy - I live in London, do you know any good ones you can recommend?

@InspectorMorse you asked a question in your previous post - "is he losing weight?": actually he's gained weight! I nag him all day to eat his food so that might have helped

 

[InspectorMorse]

I did pose the question to my vets recently, whether it was worth continuing with depocillin given that he;s been on it for ages. They said might as well carry on, which is the safest answer to give. I remember quite early on when he first started the depocillin, and as soon as we took him off it, the abscess came back. Which is the rationale as to why we've continued with it, to this day

We did have a recent blood test (is that what you mean by blood profile?), which was the one that indicated a low count of EC bacteria. I'm not sure if they checked anything else? Your logic does make sense in terms of the impact of elongated roots. He had nearly half of his teeth taken out about a year back...and somehow still bounced back from that!

I've never thought about physiotherapy - I live in London, do you know any good ones you can recommend?

@InspectorMorse you asked a question in your previous post - "is he losing weight?": actually he's gained weight! I nag him all day to eat his food so that might have helped

No personal experience but have heard good reports about her

Danielle McMahon

Danielle has a great passion for animal welfare and a love for science, in particularly anatomy and rehabilitative care. She started her studies with a 3 year Bio-Veterinary degree which swiftly led her to a postgraduate Veterinary Physiotherapy degree. Danielle initially worked her way up to...

www.theneighbourhoodvet.co.uk

McMahon Veterinary Physiotherapy

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[dex179]

Thank you @InspectorMorse I'll look into it

 

[joey&boo]

its nice to read Dexter has improved some, even if his head tilt remains the same

 

[bunny momma]

Sending more vibes for continued improvement for Dex.

 

[SarahP]

You are doing a great job for Dexter. I have everything crossed!

 

[dex179]

Thank you all for your well wishes

His appetite is good but it feels like sometimes he forgets to eat? Mobility is up and down, but all he can do is go in circles if he ever moves!

I've got the physio coming in for Monday so I'm really hoping it will help Dexter

I have a question - Dexter hasn't been eating his cecotropes poo. What do you think this means? He hasn't eaten it for a month say.

 

[InspectorMorse]

Thank you all for your well wishes

His appetite is good but it feels like sometimes he forgets to eat? Mobility is up and down, but all he can do is go in circles if he ever moves!

I've got the physio coming in for Monday so I'm really hoping it will help Dexter

I have a question - Dexter hasn't been eating his cecotropes poo. What do you think this means? He hasn't eaten it for a month say.

This isn’t unusual when the Rabbit has severe vestibular symptoms. He will feel too dizzy to reach down to his bum to eat his cecotrophs. You need to put them in front of him as you would with food. If you can do this ASAP after he passes them he will hopefully eat them.

What medications is he on now ?

Are you giving him a probiotic such as Fibreplex ?

Fibreplex for Rabbits - From £8.66

A high fibre paste formulation for rabbits and small pets. Fibreplex for Rabbits provides palatable, easy to administer extra dietary fibre to encourage normal hind gut function. Includes beneficial micro-organisms to rapidly populate the gastrointestinal...

www.vetuk.co.uk

 

[dex179]

This isn’t unusual when the Rabbit has severe vestibular symptoms. He will feel too dizzy to reach down to his bum to eat his cecotrophs. You need to put them in front of him as you would with food. If you can do this ASAP after he passes them he will hopefully eat them.

What medications is he on now ?

Are you giving him a probiotic such as Fibreplex ?

Fibreplex for Rabbits - From £8.66

A high fibre paste formulation for rabbits and small pets. Fibreplex for Rabbits provides palatable, easy to administer extra dietary fibre to encourage normal hind gut function. Includes beneficial micro-organisms to rapidly populate the gastrointestinal...

www.vetuk.co.uk

I've been putting the cecotropes in his face every day and as soon as they come, but he isn't interested at all they don't smell or look any different from before.

Right now I am only giving him metacam. I decided to stop the treatment with panacur.

I have quite a few fibreplex at home - should I be giving him this? Do you think it'll help him with eating the cecotropes?

Unfortunately his diet has been wetted pellets for a while now. He won't touch greens and he's never eaten hay

 

[InspectorMorse]

I've been putting the cecotropes in his face every day and as soon as they come, but he isn't interested at all they don't smell or look any different from before.

Right now I am only giving him metacam. I decided to stop the treatment with panacur.

I have quite a few fibreplex at home - should I be giving him this? Do you think it'll help him with eating the cecotropes?

Unfortunately his diet has been wetted pellets for a while now. He won't touch greens and he's never eaten hay

His cecotrophs probably taste ‘wrong’ to him due to a change in the balance of bacteria in his cecum caused by a lack of fibre and being on medication. Fibreplex might help restore a better balance of bacteria in the hind gut. Once this happens his cecotrophs should taste better (to him). No guarantees though. I would give it as it won’t do any harm.

Re medication, so you have stopped both the panacur and the antibiotics ?

 

[dex179]

His cecotrophs probably taste ‘wrong’ to him due to a change in the balance of bacteria in his cecum caused by a lack of fibre and being on medication. Fibreplex might help restore a better balance of bacteria in the hind gut. Once this happens his cecotrophs should taste better (to him). No guarantees though. I would give it as it won’t do any harm.

Re medication, so you have stopped both the panacur and the antibiotics ?

Yes I've stopped panacur and antibiotics for middle ear infection. Still giving him daily injection for depocillin for the tooth abscess - as mentioned it's been daily for 4 years and the vets said just keep going.

I'll try the fibreplex in that case, might as well give it a go Hopefully he likes the taste of it again! I'm more worried about the long term impact of him not eating them

 

[Omi]

Sending lots more vibes for Dexter. Hopefully the Fibreplex will help with the cecotrophs.

 

[bunny momma]

Sending Dex lots more positive vibes. Caring for a disabled bunny can be stressful with ups and downs. Dex is lucky to have you. Hugs to you too.