Head Tilt-Twinkles

[Pipp]

Just got a call from a woman with a bunny with head tilt.

History:

She has two bunnies - one lop, one uppity ear bunny.

One, then the other, came down with a weepy eye four months ago. The vet prescribed oral Chlor Palm and I think Doxycycline. (She said it was oral, but I think it must have been drops?? I'll have to check, she lost her phone connection).

It cleared up, but...

Right around Christmas, the lop (which she says only weighs 2 lbs, but I suspect he's 2 kg), came down with head tilt.

He's eating and reasonably straight, but rolls when stressed, which is when she takes him to the vet (and when he gets his meds).

She now has him on 50 mg penicillin injections (duplocillin, which I assume is Canadian bicillin -- (150,000 I.U. procaine penicillin G and 150,000 I.U. benzathine penicillin G) and she says injectable Baytril.

One of them -- or both -- is tough to inject with the needles she was given. I don't know the gage. She had a hard time sticking it in, and it would blow out the connection when she hit the plunger).

She also has him on Panacur, which she herself requested after seeing it on a website somewhere.

I'll be calling her back for more info, but if anybody has suggestions off the top about needle gages and the drug regime, chime in!

sas :?

 

[Maureen Las]

Is there any way that she can get some lactated ringers from her vet to to dilute the bicillin ( what she has is bicillin) ..it is very easy to give when it is diluted. I have never had a clogged needle.She can use a 21 gauge needle to draw up the bicillin.
I usually then switch needles to a 25 gauge needle to draw up theLRas it is smaller diameter and doesn't hurt as much when injected .........but she wouldn't have to do this and could use the 21 gauge to give the injection.

The smaller the number the larger the diameter of the needle so she can draw it up with even a 18 gauge needle but then if she use the same needle it is going to be more painful to the bun

I have never given bicillin that was not diluted but can only imagine the problems that this would be.

I have only given baytril Intramuscularly . If she is giving it sq it should be diluted as it is extremely irritating to tissue and often cause sterile abscesses

http://www.medirabbit.com/EN/Injection/Extracting_medication.pdf

http://www.medirabbit.com/Safe_medication/Antibiotics/Safe_antibiotics.htm
the dosage of bicillin is 20 mg-15mg/kg every other day

If she can get and read these articles off med-rabbit it maybe helpful to her

 

[ra7751]

Umm....I don't know if I would use the Pen and the Baytril together. I am not a real big fan of Baytril....and the Pen has a much broader coverage than Baytril so it's probably a waste of money. The Pen is very thick. It is even thicker since it requires refrigeration. That drug burns like crazy going in....so I buffer it with either Lactated Ringers or Sodium Chloride. Not only will this cushion that burn, it will also dilute the drug a bit and make it easier to inject. A good all around needle is a 21g. I use that gauge needle on a butterfly (winged) catheter with a 12" catheter. I attach the catheter to a syringe with a luer lock (a twist lock). You can even get 1cc syringes with this lock....I have seen 3cc, 5cc, 10cc, 30cc and 60cc. This is a wildlife trick to administer fluids by "pushing" the fluids in with a syringe. It's a lot faster. With head tilt, you should also be adminstering fluids anyway. If you are using drip infusion, there is a port on the line that you can slowly inject the Pen into the stream of ingoing fluids.

I really think your vet needs to step up the treatment. Most vets are far too conservative in treating vestibular issues in rabbits. And I have a feeling here that this rabbit might have escalated on you. When you have a rabbit with positional nystagmus (posture OK unless stressed) I start thinking brain stem issue.The stem can easily become infected from a deep ear infection that is not resolved quickly. This is a particularly difficult situation to treat. I would suggest(keeping in mind that I am not a vet) talking to your doctor about usinga drug that does carry some issues(for theperson handling the drug...not so much the rabbit).With"walled off" infections like a brain stem (also with something like a LRI), the drug Chloramphenicol can be very effective. There are some humans that can develop a condition known as aplastic anemia from just handling the drug. Gloves and hand washing are appropriate protocols when using this drug. I have also had success treating many infections by using Convenia. Dosing is slightly different that with dogs and few vets have to guts to use it. But it works against bacteria sensitive to Cephalosporins. A note....we use Cephalosporins against bacteria resistant to Penicillin. This class of drugs, like Penicillin, should never be given by mouth. They are safe and effective only as injectables.

Treating vestibular and/or stem infections should include lots of support protocols including light sedation(valium is a good choice) during stressful situations, pain management and husbandry support with nutritional and fluid therapy. Sounds complex but is manageable once you learnto work a schedule with it.

I can provide you with tons of information onappropriate treatment for vestibular/stem infections if you need it. I really suggest stepping up the treatment here.

Randy

 

[Pipp]

She's off to the vet already, may not see this until she gets back, but she'll be asking about Convenia I'm sure.

The vet told her she'd give her a 'screw on' needle, not sure what that means.

And she confirmed to me that the Doxycycline prescribed for the teary eye was oral. I didn't think that was a good idea. ?? It didn't upset his tummy, though.

More when I hear back from her.

Thanks!!


sas

 

[ra7751]

The screw on is a luer lock. But it is safer with a catheter. A hard needle can rip the skin if the rabbit bolts while the needle is in. The catheter is flexible and gives some "wiggle room".

I have used Doxycycline against strep....it is oral and I had no problems with any GI upset.

I am sure the Panacur is a response to the misinformation regarding the perceived connection between head tilt and EC. Probably won't hurt....won't have any worms in the gut anyway.

Randy

 

[Pipp]

ra7751 wrote:

I have used Doxycycline against strep....it is oral and I had no problems with any GI upset.

Ah, good, I must have thinking of another one, whew.

I hope the bunny is okay. :?


sas :?

 

[Flashy]

Just to add about the Convenia. My foster Tilly has head tilt. We had her on weekly Convenia injections for 2 months. and she has improved no end, although has been left with a residual tilt due to going without treatment for so long (she was a cruelty case).

We did use Fibreplex with it to start with (but I'm not sure you have it over there) because we weren't sure how her gut would react but she had no gut problems with it in anyway.

We started doing it every two weeks like for cats, but we found on day 2 (as in two days after the injection) she showed improvement, and then on day 10 she would tilt back over, so we decreased the time span until she didn't tilt over in between and she ended up having it weekly in the end.

 

[ra7751]

Convenia has been great for my rabbits....I have used it in domestic and wild rabbits as well as squirrels....and one of my volunteer vets has used it in domestic rabbits and guinea pigs. It does work best in rabbits dosing SQ once a week. I have had no adverse reactions at all to it. Most vets won't use it because Pfizer had on the web site that it should not be used in rabbits and guinea pigs. It was because they have not tested it in those species....we have offered to run validation protocols if Pfizer would allow us to.

Randy

 

[bpotter2]

Hi, Randy!Pipp has been an amazing help through my bunny's and my ordeal! I am so thankful we connected! Thanks to her advice and yours, I think Twinkles might have a decent chance.

Twinkles had a Convenia injection today and I am putting aside the Baytril injections in favour of the oral ChlorPalm.I have a couple of questions. ChlorPalm is oral, right, not injected? I only have oral. Also, what amount of Convenia should Twinkles have? Just want to make sure the vet is giving him the right amount. I am a bit confused because, although we officially measure weight in kg, lots of people, including vets still measure in pounds. I am not sure, now, but I think Twinkles weighed 2.1 kg, but that could have been pounds.

Thanks so much for your advice. I had a bunny, Pippi,years ago that eventually became paralyzed from the neck down. I got her to a vet early but over the months, she slowly deteriorated. She did plateau and became quitepeaceful. She was treated with Baytril, nothing elseand for a very long time. So, I feared using only Baytril with Twinkles. Pippi lived for another three years. She was content. I used a beautiful wooden doll crib with lots of padding as her bed, so she couldn't fall out or otherwise hurt herself. We took her everywhere with us, in our arms, wrapped in a blanket, even on afew trips to the US! The atmosphere at Customs became quite jovial whenever we came through! They all adored her! Pippi became well known in our community. Everyone knew about her. She was even in a rock video! A love song about a fellow in love witha girl and her much loved bunny.

Pippi was such a sweetheart! Whenever I think of her, holding her limp little body against my chest with her head nestledbetween my neckand shoulder, I miss her so much! Anyway, she did not pass away from this illness. One afternoon, my Mom put Pippi in her bed which was on the floor. It was summer, so we had the door open. I was in another part of the house. Mom went to the bathroom, I came in 2 minutes after she left the room and found Pippi on the floor. I could not figure out what had happened until I saw a strange dog in the other room heading for the door! Pippi's back legs were broken. I rushed her to the nearest vet and he gave her antibiotics, pain meds and carefully wrapped popsicle sticks along her legs to keep them from moving. We took her home and she seemed okay. The next day, she ate and curiously watched everything that was going on around her. We tried not to move her and we really thought she would make it. That night, she got weaker and weaker untl she passed at 3 in the morning. Even after she had gone, I could not stop stroking her sweet little head.

Anyway, just wanted to let you know how much you have helped my Twinkles and me with your advice. I now have confidence that Twinkles just may have a chance at being alright. I am so, sograteful!!!

Kathy

 

[ra7751]

Hi Kathy,

I hope we can help. Pipp is certainly a valuable resource to have.

I don't know if I would use those two drugs together. It would certainly have coverage over a wide range of bacteria. But we don't know if there would be any contraindications between the two. Convenia has only been available in the US for a short time. I have used it only as a stand alone...and it's worked everytime both in my rabbits and squirrels. I prefer not to add antibiotics in the gut if I don't have to even thought the ChlorPalm is probably the easiest of all oral abx on the GI flora.

Dosing of Convenia to rabbits is, so far, standard amounts. The only difference is that it seems to work best injected once per week. It is a very concentrated drug (80mg/ml as reconstituted) so the actual amount given would be quite small. If you could get her definite weight, I could calculate based on standard practice.

Pippi sounds like a very special rabbit, and like my Sabrina, is still very special even after she had to leave. Last week marked the fifth anniversary of losing her. She is my inspiration for learning all I have and continue to do with rabbits and any other critter that needs help. And she, like your Pippi, was suffering from a then fairly unknown protozoan infection we call EC. I have a personal vendetta against that little worm. I have learned a lot....and I know that a lot of the information available about that condition is way off base. EC is a cascading type issue that has an initial onset of some degree of paresis, followed by what appears to be a plateau or even some degree of resolution and then a general and advancing decline in motor functions usually starting with the left rear leg. Eventually, the paresis will take over most of the body...and this infection causes major issues all thru the body. It takes a very special person to deal with the issues of this type of "special needs". I salute you and give you "golden cottontails" for your efforts. I am sure Pippi knew just how special she was, and is.

Randy

 

[bpotter2]

Hi, Randy. Thanks for clearing that up. Twinkles will be happy he doesn't have to be subjected to stuff squirted into his mouth, anymore. Me, too.

Twinkles had the injection yesterday afternoon. He has not shown any signs of improvement over the last few days. His head is actually, maybe a little more tilted, but he is eating well and gets about, a bit wobbly on his feet. I sure hope this will help him.

The vet does not want to give Twinkles the injection in 7 days. She is worried it will be too strong. I am going to try to get her to contact you to discuss this, if that's alright. She seems to be a very caring, well informedvet and is open to suggestions. I understand her hesitancy, but maybe if she was confident she was being informed by someone with experienceinstead of coming from me, someone she just met a few days ago, she might be more willing to give it a try.

I was given a prescription for an anti-nausea med, as the vet did not have any, but the pharmacy did not have any, either. The pharmacist recommended 1/2 pill of Gravol diluted in water. I have not given him any, although I am worried about Twinkles next vet visit. He was almost out of his mind yesterday on the way home. He showed signs of being extremely dizzy. Any suggestions?

Acurious thing, this last summer we had a squirrel that wasunsteady on his feetand hanging his head a little. I was scared he would fall as he scamperedalong the tree branches. He stopped coming after a while and I'm afraid that he probably didn't survive. I only just remembered this when you said you treated squirrels with Convenia.

Again, I want to thank you for all your advice. It has been such an ordeal! You and Pipp have allowed me to believe theremay belight at the end of the tunnel!

Kathy

 

[ra7751]

Hi Kathy,

I will be glad to talk with your doctor either by e-mail or by phone. The only two things.....she had to know that I am not a vet and I have to make sure she is a vet. She will understand the ethics of that from her part and the legalities for both of us. Convenia's effects does seem to drop off after 7 days. Just like Penicillin....it was also considered "too strong" at first and was injected only once a week. I do Pen every day under some situations.

I assume the Gravol is meclizine. I haven't researched it this morning due to time. In the US, we have a product made with meclizine called Bonine. It is very tasty....berry flavored....and most rabbits will eat it as a treat. For some reason, it doesn't work with all rabbits.

Gotta head to work. I hope I can talk with your vet.

Randy

 

[JadeIcing]

I hope Twinkles is feeling good today.

Randy I was wondering Ringo who has used the Zithromax/Pen G combo would the Convenia be better? Or should I continue with what we are using during his bad bouts.

 

[ra7751]

Convenia is a Cephalosporin. I have been using it when I have bacteria resistant to the Penicillin. I would personally stay with the Pen G/Zithromax as it actually has better coverage overall. But I have had some amazing success with Convenia so I would at least discuss that option with your vet. I have also been using Chloramphenicol more since it can more easily reach those walled off infections....and it passes the blood/brain barrier. That is important to know if an ear infection escalates into the brain stem or brain itself. I just hope that Convenia doesn't meetthe fate of Baytril in animals or the approaching issues with Zithromax in humans....over use in inappropriate situations. I really hope the vets will exercise restraint in using this drug....and that the general public willget better educated on the overall use of antibiotics. If you have an inside view of the medical world....we are getting nastier bacteria and viruses that are becoming more and more resistant to our drugs....and few new drugs are "in the pipeline". And with the economy, I fear that R&D will fall further....and things might get bad. Just look at MRSA in humans. So I would urge any use of these few new drugs we have available to be used carefully and under the direct supervision of a skilled vet.....as I know you do already.

Randy

 

[Pipp]

another note from Kathy, via email...

-----Original Message-----
From: KATHY xxxxxxxxxxxxxx]
Sent: Tuesday, January 27, 2009 12:43 AM
To: [email protected]
Subject: Twinkles



Hi. Update on Twinkles. He started convulsing Saturday evening, exactly 1 week after his first injection of Convenia. He was showing improvement Saturday morning, head not always tilted, scampering about, I was quite happy. I thought I would have enough time, at least until Monday to try and find some way to convince the vet to do the second injection. When I talked to her last, onThursday,she refused and instead offered to do an x ray and possible drain of the ear at a cost of over $450. I was a bit taken aback, considering the Conveniaseemed to be working although slowly. I did not know what to do when Twinklesstarted rolling,as it was after 8 PM. I found the Chlorpalmand have been giving it to him since, as well as the Metacam. He stopped convulsing after I gave him the Clorpalmand Metacam. I also held him snug againstmy chest for more than a half hour to keep him from flailing about. When I finally let him go, he flopped around and rolled a few times but as I helped him get on his feet, he managed to hop under the sofa. He rolled a few times under the sofa then seemed to stabilize. I was freaking!

Sunday, he was quiet, mostly under the sofa, coming out only to grab a few nibbles. He did not eat much, although he came out a few times, so I think he got enough to keep his tummy moving. The same behaviour today. Rolling every time after I give the meds, twice a day. I have not noticed any more rolling other than med time. Not a lot of poopsand a bit small and hard. I started putting his vegin a large shallow bowl full of water to try to keep him from getting dehydrated. He doesn't seem to mind, same for Bon Bon.

I am not sure now how to proceed. The thing that really bugs me is that the vetsshould have done tests, the first time we went in. Apart from the blood test done 4 months ago when I took Twinkles in for his weapyeye, which came back negative, neither vet has bothered to do ear swabs or further blood tests. They both looked at his teeth and dismissed that possibility. I just read that bunnies have back teeth, I'm not sure the vetseven looked at those, just the front teeth. They are both supposed to be experienced bunny vets. I am so frustrated!

I am not even sure I will get a refill for the Chlorpalm, or penicillin or whatever. I hate to go to yet another vet, subjecting Twinkles to more stress. He reallyconvulsed last time, travelling in the car with his dizziness. Not to mention another possible switch in medsor the same lack of interest. I feel like screaming!!! I really think these vetsdon't really give a darn. Neither vetdid any researchinto what are the recent protocols for rabbits or followed normal procedure, ietesting.

I'll let you know what happens. Sorry about being so angry.

Kathy

 

[bpotter2]

Hi, sorry I haven't been able to get through before. Thanks to all that have taken the timeto help.Can anyone tell me how long you can use Metacam on bunnies? I read somewhere it can be used indefinately, somewhere else for a maximum of 3 days.

Thanks, Kathy

 

[Flashy]

It can be hard having a bun with head tilt as you know, because you have bad days as well as good days. Maybehe is just having some bad days?How is Twinkles doing now?

Have you been prescribed something to help with how disorientated he must be feeling? I know over here we use Meclizine, but not sure about over there.

In terms of Metacam I've used it for a few weeks. Randy always emphasises the importance of proper hydration because it can be hard on the kidneys. Often people in the UK talk about using Zantac (I think?) whilst using Metacam because it can damage the stomach lining (sort of like howibuprofen and aspirin can irritate a persons gut, it can do a similar thing to a rabbits gut apparently), so whatever that medication is, it just protects the stomach.

I'm going to reply to your PM in a bit and send you some hope, I hope

 

[bpotter2]

Update on Twinkles.

Talked to the vet this evening and it seems we are back to where we were at the beginning. She does not want to give weekly injections of the Convenia and would rather go back to the Baytril and Penicillin. She is not confident about the Convenia, is worried that not much is known about it. I told her I could not afford the $470 xrays. She said that was just for the xrays and if needed, the drain procedure would cost extra. I asked her what she would do if Twinkles was her bunny and she said the Baytril/penicillin.

I told her I started giving Twinkles the ChlorPalm on Saturday evening but still thinks the Baytril/Penicillin would be better.

Twinkles was worse today, more unsteady on his feet, doing circles, not knowing which way to go. Head severely tilted and almost fell over a few times. Eating, not a lot, but still trying hard, brave little boy!

Kathy

 

[Pipp]

Twinkles needs something fast, either more Convenie or more penicillin.

If you think you saw improvement with the Convenia, go to the Arbutus Clinic. The x-rays are way cheaper there, although I think a Convenia shot is $60. They will give him another shot. I'm not sure about Dr. Brondwin, but Dr. Martinez was well aware of the dosage. He's not there anymore, but I"m sure Dr. Brondwin will have the info on file or at least will listen.

They'll probably say to use the ChlorPalm with the penicillin shots, except that they'll mix the penicillin with a saline solution thinner so it's much easy to administer.

You have to decide what you think he responded to the best. If he seemed better for the first seven days of Convenia, try it again. If you even saw limited improvement with the penicillin, then I'd say stick with that route. I honestly think you'll be able to give him the shots.

I don't think there is a ton of difference between the choices. I think the penicillin has a good chance of working, ditto with the Convenia. But I didn't see how he reacted in the days following the treatment. I'd base the next step on that.

I don't recall if Meclezine was part of the protocol or not, the anti-dizzy drug, but worth a try. Also nake sure he gets a pro-biotic and plenty of fluids and nutrition. And stay stress free around him, it's catchy!

Hope this helps!

sas :clover:

 

[Little Bay Poo]

Ours was on the Baytril / Pen G combo and got better although he still has slight residual tilt. The Baytril was used every day for two weeks to help bridge the gap on the 3 days which he was off Penicillin (Pen G shots were on 7 days off 3 and we did these for a few months). This was done because every time he was off Pen G for those three days, he would get worse and start to roll.

I would also suggest getting your bunny on some kind of injection / treatment like Pipp says. With ours it seemed that the days when he was off shots were the worst, and we really needed to keep him on them consistently to stop the rolling. If you'd like to read over the thread about Ronnie and his head tilt here is a link:

Ronnie has Head Tilt