5bunniesin40years
New Member
Hi everyone,
I apologize for jumping in to this forum to get rather than give help, but I've been desperately searching for answers for weeks now and think the next best option is to ask for help with my specific case.
Ruby, my dear, sweet 2.5 yo girl, went from wonderfully active one day to gravely ill the next morning. When she did not race downstairs for breakfast as usual on the morning of 12/12, we found her under the bed, uninterested in food placed before her. Upon close examination, her head was slightly tilted, her eyes were starting to roll, her balance was off and she didn't want to move. We took her straight to the exotics vet.
The vet suspected either ear infection or EC, but was leaning towards EC because she didn't see anything in the outer ears, and because we had brought her in during the summer for what we considered to be an unusual amount of thirst/peeing. At this summer appointment, her kidney function was fine, but we had an EC titer done and found her to be positive on the measurement that shows exposure, but not active infection. Given cost and uncertainty of whether a repeat test would give us diagnostic information at this point, we didn't push for another EC test at this first appointment. We did agree to start meds for EC and ear infection, and to hospitalize her for assisted feeding and fluids, because she had no interest in eating. That's when this nightmare began.
She has been in and out of hospitalization and on/off a number of meds, but isn't clinically responding to any of them, and while I'm questioning the choices made earlier in her treatment, I guess what I really need now is advice on what else to try and for how long. I have exhaustively googled all possible variations on the theme of "head tilt rabbit recovery" to look for slivers of hope, but while I'm pretty sure I've read most objective sources, I can find both happy endings and sad endings in forums such as these (I've even gotten pretty good at searching for one vs. the other, depending on my state of mind at the moment).
So, here is what we've tried:
Day 0 (12/12) -- Nystagmus, poor balance, slight head tilt. Start fenbendazole, start SMZ-TMP, start chinese herbal meds for dizziness
Day 2 (12/14) -- Nystagmus/balance worsens, head tilts t0 9 o'clock; do x-ray, see "possible" thickening of bullae (sp?). Switch meds from SMZ to Camphenicol, stay on fenbendazole, start meclizine
Day 4 (12/16) -- Improvement. Nystagmus slows, appetite better, slightly more alert, with head closer to 10 o'clock. Sent home with above meds, critical care
Day 6 (12/18) -- Ruby's head tilt's past 9 o-clock, starts mild rolling. Run out of meclizine mid-day, call for refill, told to wait it out until tech appt next day; circles cages with agitation and start rolling more throughout night
Day 7 (12/19) -- Downturn. Significant rolling, cannot be righted, brought to vet early on emergency. Try acupuncture, meclizine re-started, switch from Fenbendazole to Albendazole, re-hospitalized with assisted feeding and fluids; looks slightly better when we visit in afternoon
Day 8 (12/20) -- Improvement. Ruby "stabilizes," (i.e. resumes eating on her own, but still occasionally rolling with handling). We go out of town for previously planned visit to NY (we live in NC). More on this later. Ruby stays in care of vet in step down from hospitalization (boarding + meds, instead of full-on hospitalization + assisted feeding). Meds stay the same.
Day 9-10 (12/21-12/22): Ruby's head stays at 9 o'clock and rolls occasionally, but continues eating on her own.
Day 11 (12/23): Camphenicol runs out; authorize re-fill of Rx and inquire about adding something else, but since she is stable, vet doesn't think this is necessary.
Day 12 (12/24): Same as Day 9-11, we celebrate Christmas with cautious relief.
Day 13 (12/25): Downtown #2. Unbenknownst to us (clinic was closed to calls/visits on Christmas day, though techs were going in for feedings/treatments 3x/day and vet was in 1x/day), things go south, again. Ruby starts rolling uncontrollably, cannot eat on her own. We find out later that she does still has appetite, but physically cannot manage to eat more than a few nibbles because it triggers severe rolling.
Day 14 (12/26): Vet calls with bad news about downturn. Starts talking about quality of life, suggests we come see her to "discuss our options." We (my husband, 2 human kids and other bunny) are still in NY. I put my husband on a plane that night to see Ruby in person the next morning. I indicate to vet that I've read that recovery from head tilt can take awhile and we still want to fight for her. I ask about more meds. Vet agrees to acupuncture, thinks we should continue with Camphenicol and Albendazole, in addition to resuming hospitalization with syringe feeding and fluids. I know that Camphenicol is one of the best of ear infections, though I worry about blood count warnings for the Albendazole and wonder why we didn't get Fenbendazole its 28 day course before switching that one, given data. Vet calls at end of day to say Ruby looks a little more alert, and that severe rolling had abated slightly.
Day 15 (12/27): Husband visits Ruby in morning and again in afternoon before flying back to NY. While somewhat out of it in morning, she has moments of alertness and nibbling greens and hay and enough rabbity presence to convince husband that she still wants to fight. I am relieved and agree when I see his videos. Husband tells vet of my desire to add more antibiotics; she relents and adds back SMZ-TMP (!).
Day 16-17 (12/28-12/29): Severe rolling resumes. On-call vet (also happens to be clinic owner) (it's a weekend) tries a couple doses of Midazolam for the rolling, but it apparently has little effect. Ruby needs to by syringe fed because she cannot physically reach her food without severe rolling.
Day 18 (12/30): Ruby is "the same." I call vet and ask if there is anything else we can add to meds. I actually want to get off SMZ-TMP because I haven't read it being of any value, but I do not want to insult the main vet on her case who repeatedly prescribed it (different vet at clinic prescribed the camphenicol). From what I had read, penicillin could be a decent option, but vet is in euthenasia frame of mind at this point and suggests that the pain of penicillin injections would be cruel for animal already in considerable distress from uncontrollable rolling, but agrees to add in Baytril. So, add Baytril. I make decision to shorten our trip and return home to bring our baby girl back into our loving, if technically way less skilled at administering meds/feeding home. We drive 10 hours back.
Day 19 (12/31): Ruby is the same. We take her home, with lots of education from the tech on administering her many meds. She does seem a bit happier to be home, and with trial and error, we figure out a safe enclosure situation (old baby bumpers on a 2x2 x-pen square with rolled up towels along all sides and many layers of padding beneath). We struggle but manage meds and feeding. We notice that Ruby's meclizine had been backed down during her boarding/hospitalization and I decide to increase it back to 3x/day, to see if it helps the rolling.
Day 20 (1/1): Today. Even with extra meclizine, it seems that Ruby is rolling even more than yesterday, and the severity of the rolling is difficult for both us and for her. Even in her small, padded space, she can flip over and over in the same position 4-5 times before her exhausted body finds a position in which to rest. If I had to describe it better, the word "rolling" wouldn't be strong enough -- it's like she has this pressure within her to violently flip again and again until she is worn out. Holding her in place can help, but not all the time. She's gotten the longest breaks from this rolling today while we were holding her to give meds/food, which took about 1 to 1.5 hours each time. That said, she is hungry, she is still looking for food and I think attention in her moments between rolls, and she still tries to groom. But today she is standing less than yesterday, trying to do whatever she can to minimize the rolling, but mostly to no avail.
To summarize health,
Day 0: Head tilt, dizzyness, nystagmus
Day 4: Improvement
Day 7: Downturn -- rolling begins
Day 8: Improvement
Day 13: Downturn #2 -- rolling intensifies
Day 20: Slight downturn, downward trajectory, or just down spirits?
And to summarize meds:
Day 0: Fenbendazole, SMZ-TMP, chinese herbal for dizziness
Day 2: Stop SMZ-TMP, start Camphenicol, start Meclizine
Day 6: Run out of meclizine, hell breaks loose
Day 7: Re-start meclizine, stop fenbendazole, start albendazole
Day 11: Refill Camphenicol (day 9)
Day 15: Add back SMZ-TMP, try Medazolam
Day 18: Add Baytril
So. Is there anything else we can try? Has anyone had rolling go on this long and still recover? I love this girl so much.
Sorry this is so long. There is so much more to tell about sweet Ruby and the impact she has had on our lives in her short half a year as part of our family, but today I am looking for advice.
Thanks in advance,
Melissa
(Mom to 5 bunnies over 40 years, starting with my childhood rabbit from pet store when I didn't know any better, then my first pair of rescues in my younger adulthood and now Ruby is the other half of my second pair; though I am technically 41, we adopted Ruby last May, when I was still 40)
I apologize for jumping in to this forum to get rather than give help, but I've been desperately searching for answers for weeks now and think the next best option is to ask for help with my specific case.
Ruby, my dear, sweet 2.5 yo girl, went from wonderfully active one day to gravely ill the next morning. When she did not race downstairs for breakfast as usual on the morning of 12/12, we found her under the bed, uninterested in food placed before her. Upon close examination, her head was slightly tilted, her eyes were starting to roll, her balance was off and she didn't want to move. We took her straight to the exotics vet.
The vet suspected either ear infection or EC, but was leaning towards EC because she didn't see anything in the outer ears, and because we had brought her in during the summer for what we considered to be an unusual amount of thirst/peeing. At this summer appointment, her kidney function was fine, but we had an EC titer done and found her to be positive on the measurement that shows exposure, but not active infection. Given cost and uncertainty of whether a repeat test would give us diagnostic information at this point, we didn't push for another EC test at this first appointment. We did agree to start meds for EC and ear infection, and to hospitalize her for assisted feeding and fluids, because she had no interest in eating. That's when this nightmare began.
She has been in and out of hospitalization and on/off a number of meds, but isn't clinically responding to any of them, and while I'm questioning the choices made earlier in her treatment, I guess what I really need now is advice on what else to try and for how long. I have exhaustively googled all possible variations on the theme of "head tilt rabbit recovery" to look for slivers of hope, but while I'm pretty sure I've read most objective sources, I can find both happy endings and sad endings in forums such as these (I've even gotten pretty good at searching for one vs. the other, depending on my state of mind at the moment).
So, here is what we've tried:
Day 0 (12/12) -- Nystagmus, poor balance, slight head tilt. Start fenbendazole, start SMZ-TMP, start chinese herbal meds for dizziness
Day 2 (12/14) -- Nystagmus/balance worsens, head tilts t0 9 o'clock; do x-ray, see "possible" thickening of bullae (sp?). Switch meds from SMZ to Camphenicol, stay on fenbendazole, start meclizine
Day 4 (12/16) -- Improvement. Nystagmus slows, appetite better, slightly more alert, with head closer to 10 o'clock. Sent home with above meds, critical care
Day 6 (12/18) -- Ruby's head tilt's past 9 o-clock, starts mild rolling. Run out of meclizine mid-day, call for refill, told to wait it out until tech appt next day; circles cages with agitation and start rolling more throughout night
Day 7 (12/19) -- Downturn. Significant rolling, cannot be righted, brought to vet early on emergency. Try acupuncture, meclizine re-started, switch from Fenbendazole to Albendazole, re-hospitalized with assisted feeding and fluids; looks slightly better when we visit in afternoon
Day 8 (12/20) -- Improvement. Ruby "stabilizes," (i.e. resumes eating on her own, but still occasionally rolling with handling). We go out of town for previously planned visit to NY (we live in NC). More on this later. Ruby stays in care of vet in step down from hospitalization (boarding + meds, instead of full-on hospitalization + assisted feeding). Meds stay the same.
Day 9-10 (12/21-12/22): Ruby's head stays at 9 o'clock and rolls occasionally, but continues eating on her own.
Day 11 (12/23): Camphenicol runs out; authorize re-fill of Rx and inquire about adding something else, but since she is stable, vet doesn't think this is necessary.
Day 12 (12/24): Same as Day 9-11, we celebrate Christmas with cautious relief.
Day 13 (12/25): Downtown #2. Unbenknownst to us (clinic was closed to calls/visits on Christmas day, though techs were going in for feedings/treatments 3x/day and vet was in 1x/day), things go south, again. Ruby starts rolling uncontrollably, cannot eat on her own. We find out later that she does still has appetite, but physically cannot manage to eat more than a few nibbles because it triggers severe rolling.
Day 14 (12/26): Vet calls with bad news about downturn. Starts talking about quality of life, suggests we come see her to "discuss our options." We (my husband, 2 human kids and other bunny) are still in NY. I put my husband on a plane that night to see Ruby in person the next morning. I indicate to vet that I've read that recovery from head tilt can take awhile and we still want to fight for her. I ask about more meds. Vet agrees to acupuncture, thinks we should continue with Camphenicol and Albendazole, in addition to resuming hospitalization with syringe feeding and fluids. I know that Camphenicol is one of the best of ear infections, though I worry about blood count warnings for the Albendazole and wonder why we didn't get Fenbendazole its 28 day course before switching that one, given data. Vet calls at end of day to say Ruby looks a little more alert, and that severe rolling had abated slightly.
Day 15 (12/27): Husband visits Ruby in morning and again in afternoon before flying back to NY. While somewhat out of it in morning, she has moments of alertness and nibbling greens and hay and enough rabbity presence to convince husband that she still wants to fight. I am relieved and agree when I see his videos. Husband tells vet of my desire to add more antibiotics; she relents and adds back SMZ-TMP (!).
Day 16-17 (12/28-12/29): Severe rolling resumes. On-call vet (also happens to be clinic owner) (it's a weekend) tries a couple doses of Midazolam for the rolling, but it apparently has little effect. Ruby needs to by syringe fed because she cannot physically reach her food without severe rolling.
Day 18 (12/30): Ruby is "the same." I call vet and ask if there is anything else we can add to meds. I actually want to get off SMZ-TMP because I haven't read it being of any value, but I do not want to insult the main vet on her case who repeatedly prescribed it (different vet at clinic prescribed the camphenicol). From what I had read, penicillin could be a decent option, but vet is in euthenasia frame of mind at this point and suggests that the pain of penicillin injections would be cruel for animal already in considerable distress from uncontrollable rolling, but agrees to add in Baytril. So, add Baytril. I make decision to shorten our trip and return home to bring our baby girl back into our loving, if technically way less skilled at administering meds/feeding home. We drive 10 hours back.
Day 19 (12/31): Ruby is the same. We take her home, with lots of education from the tech on administering her many meds. She does seem a bit happier to be home, and with trial and error, we figure out a safe enclosure situation (old baby bumpers on a 2x2 x-pen square with rolled up towels along all sides and many layers of padding beneath). We struggle but manage meds and feeding. We notice that Ruby's meclizine had been backed down during her boarding/hospitalization and I decide to increase it back to 3x/day, to see if it helps the rolling.
Day 20 (1/1): Today. Even with extra meclizine, it seems that Ruby is rolling even more than yesterday, and the severity of the rolling is difficult for both us and for her. Even in her small, padded space, she can flip over and over in the same position 4-5 times before her exhausted body finds a position in which to rest. If I had to describe it better, the word "rolling" wouldn't be strong enough -- it's like she has this pressure within her to violently flip again and again until she is worn out. Holding her in place can help, but not all the time. She's gotten the longest breaks from this rolling today while we were holding her to give meds/food, which took about 1 to 1.5 hours each time. That said, she is hungry, she is still looking for food and I think attention in her moments between rolls, and she still tries to groom. But today she is standing less than yesterday, trying to do whatever she can to minimize the rolling, but mostly to no avail.
To summarize health,
Day 0: Head tilt, dizzyness, nystagmus
Day 4: Improvement
Day 7: Downturn -- rolling begins
Day 8: Improvement
Day 13: Downturn #2 -- rolling intensifies
Day 20: Slight downturn, downward trajectory, or just down spirits?
And to summarize meds:
Day 0: Fenbendazole, SMZ-TMP, chinese herbal for dizziness
Day 2: Stop SMZ-TMP, start Camphenicol, start Meclizine
Day 6: Run out of meclizine, hell breaks loose
Day 7: Re-start meclizine, stop fenbendazole, start albendazole
Day 11: Refill Camphenicol (day 9)
Day 15: Add back SMZ-TMP, try Medazolam
Day 18: Add Baytril
So. Is there anything else we can try? Has anyone had rolling go on this long and still recover? I love this girl so much.
Sorry this is so long. There is so much more to tell about sweet Ruby and the impact she has had on our lives in her short half a year as part of our family, but today I am looking for advice.
Thanks in advance,
Melissa
(Mom to 5 bunnies over 40 years, starting with my childhood rabbit from pet store when I didn't know any better, then my first pair of rescues in my younger adulthood and now Ruby is the other half of my second pair; though I am technically 41, we adopted Ruby last May, when I was still 40)
