Chalk has head tilt :(

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mr_mouse_chalk

mr_mouse_chalk

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Hi all,

long time since I've posted here - normally leave it to Jen, but she's in hospital tonight unfortunately (she had Gall Stones flare up over the weekend so had to have her Gall Bladder removed today)... she's on the mend fortunately and hopefully home tomorrow.

The worse news at the moment is that our little baby Chalk has developed head tilt.
I came home yesterday and she was being very strange - hiding in the corner of her cage, trying not to move. Then when she did she went outside and just scrunched herself up in the corner of a pen, and didn't seem to notice when it started raining on her.

I brought her in and could tell she wasn't right straight away - she seemed to be dragging one of her back legs. Took her to the overnight vets and they gave her some metacam and thought it was just a bit of pain....

This morning she was worse. She tried to clean herself and fell over sideways as she stood on her back legs to do it. She could barely move without stumbling into things. Took her straight to the vets who could see 'flickering' reactions in her left eye and her head was slightly tilted. They admitted her straight away and took some blood tests - but have started treatment whilst waiting for the results.
She's on a long course of Panacur and also Antibiotics - I believe she's currently on Baytrill.

I've read lots of horror stories about Head Tilt - but don't really have any idea how bad this is going to be. The vet seemed to think it being caught early (two nights ago she was absolutely fine!) is a good thing.

Any thoughts?

Are there particular antibiotics that are effective here that I should be pushing the vets for?

Any help appreciated - out of my mind with worry between Jen and Chalk...

Steve
 
I would say that I would attempt to get a more aggressive treatment from your vet. Baytril is rarely effective these days. And Panacur, while not harmful, is from the long held and very incorrect notion that E Cuniculi causes head tilt....it doesn't. And if it did, Panacur is not very effective since it can't penetrate the blood/brain barrier. Ponazuril can penetrate the blood/brain barrier and is the drug of choice if EC is involved. Most head tilt is caused by either obvious trauma or by an inner and/or middle ear infection. The correct method is to culture the "down" ear and see if a bacteria grows. Since we know what usuallyis usually found in vestibular infections, I use either a combination of Penicillin (safe only as an injectable) and Zithromax OR Convenia (again, safe only as an injectable). While EC can always be involved, tilt is not a primary presentation of this affliction. EC compromises the immune system and allows opportunistic bacteria to make an appearance. Since the ears are the easiest infection point, you get tilt. The worst infection is in the "down" ear. The infection may not be visible by eye.

Randy
 
Had my gallbladder out many years ago. Just take it easy.

Ruby, my Dutch girl, has head tilt and she gets along fine. Hers was from an ear infection. It was treated but redeveloped. She seems to be less tilted in the past week.
 
Well wishes to Jen, hope she heals soon.

Steve, I'm sorry to hear this news, but like Randy said, it is very treatable. I would encourage your vet to treat along Randy's recommendations. I hope Chalk improves soon. You're a great bun dad for posting for Jen! Give Chalk some head rubs from me.:)

Keep us posted.;)
 
I remember when Ronnie came down with head tilt and I thought it was a death sentence. I assure you though, it is very treatable. He is still going strong and has been clear from infection for almost two years. As Randy says, I would look into a stronger antibiotic such as Penicillin. Also, be prepared to mix something like Critical Care if Chalk stops eating. If I remember correctly, we were force feeding Ronnie for a good month because he was not eating on his own.

I hope Jen is feeling better from her surgery. What a horrible time to get news of heat tilt. My thoughts are with you, Jen and Chalk. Please keep us updated with any progress :hug:
 
I have to agree with Randy and Robin. Panacur isn't going to help if it's actually E cuniculi, and a good way to get an idea of if the tilt is from EC is to look at the eye movements--if they're side to side, the tilt is probably caused by an ear infection. If they're up and down, it could be from EC. Usually tilt is from ear infections and a strong antibiotic is needed--Baytril has its uses, like low-grade respiratory infections, some UTIs, etc, but it's really not going to work fast enough in an ear infection. With an ear infection you have to treat it quickly to prevent permanent damage to the vestibular system in the ear--if you don't treat fast enough, the tilt will become permanent.

I know bicillin (combination of penicillin G procaine and benzathine) isn't available in the UK, but what about Convenia? It's an injectible but it only has to be given every 5 days in rabbits, and it is a more aggressive antibiotic. If I remember right, Flashy's Tilly had tilt and got Convenia and it helped...

Here's a really informative sheet on tilt:
http://www.medirabbit.com/EN/Neurology/otitis_interna_media.PDF

I hope Jen feels better soon, and Chalk too!
 
Hi Everyone,

Thanks so much for the responses - Jen is home from hospital, but very sore now so not up to much typing yet.

Chalk is a different story. Having spoken to the vets the last couple of days they've been advising that she's improving, she is eating by herself (although initially they were having to syringe feed critical care)... but she isn't yet pooping so they're keeping her in at least until she does.

Blood test results don't indicate any renal problems or any other issues - but the EC specific tests aren't back yet... The vets seemed to be of the opinion that Chalk was a lot 'brighter' than when I dropped her off there on Wednesday....

All this said I visited earlier and Chalk is a long way from better. Her head is a lot more noticeably tilted than it was on Wednesday and although I saw her eating she clearly was still struggling for balance and was not the lively bunny I'm used to. Realise she is early into her recovery, but I'm worried that perhaps she's not as on the mend as they think she is.
Whilst I was holding her she got very confused and somehow flipped herself onto her back in my arms...

She's currently getting Panacur Paste, Baytrill (injectable), Vetagesic and Zantac at the vets... and so far they haven't done a culture from her ears which I am obviously going to push them to do.

I need some ammunition for when the vet calls me tomorrow:

1) Should they run a culture on the ear even if no signs of discharge/infection? (if they do how long does it typically take to get results?)

2) I suspect from everything I've read on this thread and elsewhere that she needs to be on penicillin. Because this isn't licensed for Rabbits in the UK the vet is going to need quite a bit of convincing. Does anyone have any links to published articles about the use of penicillin in bunnies being safe & effective for this sort of case?

3) As she's already on Baytrill would it be bad for her to switch before completing a decent length course?

Sorry for all the questions - just really keen to have something really bulletproof to put to the vet tomorrow when he calls me.

Steve
 
I doubt you'll win the penicillin battle. I don't think they can legally give it to her.

You may be able to convince them to combine the Baytril injectable with an oral antibiotic, though. Zithromax seems to work very well. My vet uses Chloramphenicol.

There should be some good Convenia anecdotal evidence on the board (if it's administered every 8 days and not 14 like in dogs and cats) but they're I think mostly be from lay people and not Vet info. Its still new and it's not at this point recommended for rabbits.

Has she been on Baytril before? It's not totally useless, resistance depends on the rabbit and the area.

PS: The vet will probably want to do the full seven day course of the injectable Baytril, but hopefully will be willing to combine it with the oral before then.


sas :clover:
 
Hi Sas,

Thanks for replying :)

I'm hoping they might let me sign a form to agree to use of non licensed drugs - they used to do this for Metacam before it went licensed here a few years ago... but I'm with you that the battle may not be one I can win.

Will have a scout through the forum posts this evening.

She's had a lot of Baytril in the past when she had peritonitis (along with Ceptrin) and also when her absesses came back a year or so later. So she's had it in reasonable quantity. Does repeat usage make it less effective?

Steve
 
Yes, if she's had a lot of it, she could have built up a resistance.

I honestly think you're best bet is going to be Zithromax. If the vet needs convincing, there should be a lot of newer data confirming its effectiveness in head tilt/ear infections.

It works on a lot of different bacteria, I don't know that I'd bother with a culture first, just start her on it along with the Baytril and see how she is in three days, which could be how long it would take to get the culture anyway.

Hopefully the vet will agree.


sas :clover:
 
Here's a few references to it being safe...


http://en.allexperts.com/q/Rabbits-703/2009/1/Rabbit-eating-8.htm

http://www.onthewonk.com/?p=4.What+...trk=menu:What Treatment Should My Rabbit Have


A rabbitrehome.org post:

------------
www.onthewonk.co.uk

they are fantastic and will give you ll the help you need! Katy who runs it saved my bunny when i didn't kno were to turn. My bunny had severe headtilt and i had tried all kinds of meds.Katy put me on to zithropmax and withing 2 days my bunny showed drastic improvements.
My vets don't know too much either but are always happy to listen and take on what info i tell them. My vet was amazed by zithromax and now stocks it! __________________

I'm really sorry that I've missed your recent threads about your poorly bunny
icon_sad.gif


I thought I'd share our story of our headtilt bun Wilson. He became very poorly last April with headtilt - which we didn't find the exact cause of
icon_sad.gif
However, very long story short - we had Wilson on all sorts of different meds.

To start off with he was just on baytril (antibiotics), panacur & metacam - this was when his head was only slightly tilted. He then got progressively worse & his tilt changed sides - it was so bad his down eye was almost horizontal to the floor. We then changed him to steroid injections, depocillin injections & panacur - again sadly these did nothing for him.

He was having severe rolling episodes & we had to confine him to a padded cage for around 6 weeks. Eventually after bunny mad lisa on RU suggested it - we talked to our vet about Zithromax - it's an antibiotic that is used for humans & not licensed for rabbits, but Lisa had, had great results with it her for her headtilt bunny - so we felt we had no options left but to try it.

We switched him onto Zithromax & also started him on stemetil (human anti sickness drug) - continued with his panacur & I *think* his steroid injections. After just over a week of this treatment he was well enough to come out of his cage & go back with his partner Alice. We'd kept them in the same room at all times, but had to confine Wilson to a cage so he didn't hurt himself or Alice.

I have been told & read that the best way to deal with headtilt is to treat with as much strength of medication as possible - I think basically to try to beat the infection before it gets worse.

---------
 
Hi guys,
I'm sorry I haven't posted on this sooner- it's been a case of not being able to use my laptop too much and the time have been online I've been searching for information.

We printed out the links posted here and a few other pages- I even got the name of the vet and practice mentioned on onthewonk.com who had used penicillin injections and zithromax and we took them to the vet on duty today (not the vet who's been treating her all week). Long story short he seemed very disinterested in what we said, still seemed to thi k that chalk is doing well despite her tilt looking worse- I'd say it's at 2 o-clock today :(

We went
 
To see a friend of ours who works at the pet store and has a verygood vet. That practice is closed today, as is a local 'expert place' in bristol but she called him at home and he reccommended a place about an hour away that is a referral place which specialises in exotics. Called great western referrals. We called them and have an appointment at 3.30pm (2pm here currently) so steve is getting chalk discharged now. We really didn't want to upset our vets as we've used them for a long time but given a choice between that and getting chalk the treatment she needs it's a no brainer. We're worried about the journey down the motorway but it's not too bumpy and we just feel this is time-crucial and chalk needs us to fight for her in anyway we can. We could not live with ourselves if she didn't recover and we knew that there might have been a way to help her. I've read of this place on rabbits united in the past, struggling on my iPhone hence the stilted replies and typing!

We
 
The reply box keeps filling up and I have to press send so sorry for all the half finished posts! I was trying to say that I'm googling them on my iPhone but it's tricky. Car rides are also very painful for me right now but I'm not so bothered about that, chalk is more important.

I'll post an update as soon as I have one. Thank you so much for all the advice and well wishes.

Jen and steve xx
 
Hi everyone,

Sorry to be replying on Jen's behalf - but she's had to go back into hospital this evening, she was in severe pain on the way back from dropping Chalk off at the (new) vets. She's doing ok - but because she needs some strong pain relief they're keeping her in overnight to keep an eye on her.

Chalk is now in the care of 'Great Western Exotics' in Swindon - around 50 minutes drive from us. The vet we saw there was incredibly knowledgeable and much less close minded than our usual vets have been. She talked of using injectible penicillin and other stronger (than Baytril) antibiotics.

For the time being she has catheterised Chalk to get a decent flow of fluids into her (she's not been drinking enough), and she's continuing the syringe feeding to try and get her guts moving. Despite her eating the last couple of days there were no gut sounds when the vet listened to her.

The plan is to do a full head x-ray on Monday under sedation to attempt to see any damage or fluids in the ear, she also mentioned potentially doing an MRI scan if needed.

For the time being she isn't changing Chalk's medication drastically - she's going to use the maximum safe dosage of Baytril, along with continuing the 28 day course of panacur. She's on Zantac for her guts.
BUT - the big improvement here is that this vet is happy to consider stronger antibiotics in the event that the x-ray confirms ear infections, or if Chalk is still not seeming to respond to Baytril.

In herself Chalk was more lively today digging at a towel in the vets and moving around a lot more in the carrier during her longest ever car journey. She also made it very difficult for the vet to check her teeth during her initial exam. She was still a billion miles from our usual cheeky Chalk, but she did seem to have more fight about her today than yesterday.

The vet we are seeing has quite a write up on the practices website:

"Elisabetta Mancinelli

We are very proud at GWR to have the first ever European College of Zoological Medicine. Resident in Small Mammal Medicine, and in particular we are delighted that this post is supported by the Rabbit Welfare Fund.

As part of her residency, Elisabetta Mancinelli has spent a several months in Italy with small mammal Specialist Dr Vittorio Capelli, followed by a period at Utrecht University under Dr Nico Schoemaker (better known as lead researcher on ferret adrenal disease), followed by 9 months with Dr Anna Meredith at, Edinburgh University. She will spend the remainder of her residency (3 years) here at GWR with Neil Forbes, who leads the European
College of Zoological Medicine.

For Elisabetta this is a "dream come true"; she is looking forward to working with Specialists in different countries and we are looking forward to her spending time in Swindon, helping us to further develop our rabbit and small mammal expertise!"

All in all both Jen and I are more confident she's in good hands. Just waiting for a call in the morning to see how she's doing,

Steve
 
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