Help with a tilty bunny...

[molly]

I'm sure there are a million threads out there but I have no energy to search and read through them for what I need right now.

I adopted a male bunny to be a companion to my lone female, Chantale, two weeks ago. I picked him up from the shelter on Wednesday night after his neuter and right away noticed nasal congestion. It wasn't serious and there were no secretions but it was noteworthy enough that I emailed the person in charge of the exotics department to make her aware.

Thursday he wasn't enthusiastic about food so I force fed him and booked him an appointment on Friday just in case. Of course he was not congested when we were at the vet. Vet found nothing abnormal in the exam other than watery eyes. He told me if the congestion didn't improve or worsened by the following week, to start Baytril but he didn't want to start it right away because of the mild stasis.

Saturday he was fine, poops and appetite were great. Sunday morning he was hiding and when I coaxed him out he was weaker on his left side... Started Baytril and Metacam right away, force fed and went to a fundraiser I was volunteering at. Sunday when I got home he was worse and in full blown stasis...

I started everything right away and worked hard to keep him as stable as possible until I could get him to the vet Tuesday. He was in horrible shape, awful head tilt, developed a fever (he had a low temp the day before), was rolling, no stools whatsoever. He was hospitalized by the SPCA (he was technically my foster at that point so I didn't have complete control of his medical decisions) and remained in hospital until Friday. He was treated for E. cuniculi, an inner ear infection (although there's no evidence of one) and Pasteurella. I thought the latter two were the same but the vet listed them separately.

He didn't respond to enemas or any of the other treatments for stasis at the vet and had fewer than 50 stools the entire time he was there, all incredibly small. (Smaller than mouse droppings.) I had concerns about him not recovering and the SPCA does not have unlimited resources so I adopted him and took over his care. I asked about adding lactulose but the vet would not consider it and we had a huge disagreement about his care so I pulled him out of hospital - no sense in me taking over the hospitalization costs if I have no input in his care.

Unfortunately, she would not even send me home with the same meds he was on in hospital so it's been a long few days trying to care for him. I managed to get some injectable Baytril so I'm able to avoid giving it orally and his stasis is improving but his head tilt is not improving and he will not be able to eat properly unless I'm able to change that.

Currently he is on:

• Injectable Baytril
• Pen G
• Cisapride
• Infant Gravol
• Simethicone
• Metacam
• Ranitidine
• Lactulose
• Metronidazole
• sub q fluids
• force feed (Critical Care)
• papaya tablets
• BeneBac

He was on Panacur but I stopped that because my vet doubts it's E. cuni and he was concerned about the effect on his liver.

My regular vet is away until Thursday but he's in email contact with me. He suggested zithro instead of Baytril but I'm concerned because he's still in GIS. He's producing about 100-120 fecal stools per day right now but they are so small. He has a hard time eating on his own and gets flustered after a bite or two. He will eat CC off my finger and munch away at leafy veggies if I hold them for him but it's not enough. His temperature is often between 37 and 38 but is slowly improving.

I don't know what to do. He's in stasis and could deteriorate any day but he won't fully recover unless we improve the head tilt. He won't be able to keep receiving injectable Baytril for much longer, he's been receiving it for a week now and that's longer than recommended already.

I know nothing about his history, except that he's supposed to be 3 years old.

He does seem happier as each day goes by and his appetite seems to improve but I can't seem to get his poops to be a nice size. I'm guessing he has a large ball of fur and food in his stomach and it's taking time to break up. Lots of gas unfortunately and the Simethicone only does so much.

He was in a lot of pain this weekend but that seems to have subsided.

Any treatment suggestions would be appreciated. Info or advice about how to care for a bunny with a moderate tilt if his is not reversible would be as well.

I'm so tired and emotionally spent. I adopted him to be a friend for Chantale because I think she's too lonely but I really hesitated because I did not want the possibility of having to care for another sick bunny at some point. I did not expect him to get seriously ill in the first week with me.

 

[JBun]

Was an x ray done of his head? That might give you a better idea of what's going on. The stasis is a secondary problem. It is important, but unless you can get the infection under control, the stasis and him having difficulty eating on his own will continue. The fact that he is pooping at all, is a good thing. As his condition improves and you can get him eating grass hay, that should help with his poop as well. This is some info on head tilt that you might find helpful. One is a detailed account of a rabbit with a very bad ear infection, and what worked to clear it up.

http://www.medirabbit.com/EN/Neurology/Otit/otitis.htm
http://www.onthewonk.com/?p=2%2EHeadtilt+experiences%2FLara+%28Detailed+Diary%29&trk=menu:Lara (Detailed Diary)
http://www.bio.miami.edu/hare/tilt.html

 

[molly]

Thank you.

The vet that cared for him last week finally transferred the file to my regular vet last night, I still don't know the full details of what the treatment protocol was. He was x-rayed the day he was admitted and there was no pus, but I've been told that sometimes it takes 2 weeks for pus to develop. I do know there was no pus in his ears when he was examined. Thanks for the links, I'll read them more throughly in a bit.

I'm still unsure about trying zithro, I'm so afraid it will make him sicker.

 

[valaria243]

I'm a little unclear to why the vet thought the panacur would cause liver issues? I've heard it can possible cause bone marrow issues but nothing on liver damage.
On the other hand I have heard the Metacam can cause liver problems which is why they usually give it for a limited time to a younger rabbit. My 10 year old, Fuzzy, is on it daily and has been for a couple of months. She has also taken 2 rounds of panacur this year and is doing well.

http://www.rabbitsonline.net/f27/what-up-fuzzy-72804/

 

[molly]

I think he was concerned about the effects on his liver because he was already taking so many medications and even the vets that treated him originally didn't think it was very likely E. cuniculi was the cause of his issues. (I looked through your thread, his symptoms really do not sound like EC.)

Metacam is processed by the kidneys, not the liver if I'm not mistaken. Taco is 3 years old - not elderly but not juvenile either.

I read through the diary and the article about treatments. Unfortunately, there is no pus to take a culture of. Taco's biggest issue (as I discovered after a check up last week) is that he has a couple of cecal impactions and that's why his GIS is not resolving. The vet said he looked better than he expected but that he still has an uphill battle and he doesn't know whether he will survive or not. If the impaction is just somewhat dehydrated matter, it will clear up in time. If it's rock hard no amount of supportive care will be able to break it up unfortunately and I asked about surgery but he said it was very risky plus unlikely to be successful.

He's now producing almost exclusively cecotrophes and tons of them, some formed some soft but at least not watery. (They were all formed before I gave him oral antibiotics but not so much since.) His fecal droppings were still dried and tiny until Saturday, the day after I started giving him the Oxbow Natural Science Digestive supplements. (I'm not saying they're the reason for the improvement but his droppings are at least 6x the size they were a day earlier and properly formed.) The vet also added another NSAID that's been really helping with his bloating and he seems happier/more active.

The past couple of days he's started eating more and more on his own (Timothy pellets, mixed grass hay, some greens) and that's also encouraging. His temperature has not dropped below 38 since I started the new NSAID even though it's known to lower body temperature. He is still congested when resting or relaxed but he does not have secretions or lung sounds. He was more active and curious over the weekend, today not as much, but generally he seems to be improving.

I don't know what to think or expect. He seems to be adapting and adjusting but I don't know how long it will take for his GI issues to clear up and I'm concerned about him being on oral antibiotics long term while he is still having issues.

 

[tonyshuman]

Maybe just injectible antibiotics for the time being? The combination of Pen G and Baytril should be a good starting point for treating a URI and/or tilt. For rabbits the GI system is the most sensitive so you'd want to stabilize that before doing extensive oral antibiotics. I would personally cut the papaya tabs as they are sugary and have no scientifically proven benefit but that is a bit controversial. I would also cut the lactulose and ranitidine, as I'm not a fan of using zantac in rabbits--more acid in the stomach makes things downstream also more acidic, which is good for rabbits. I also don't think the benefits of lactulose are large enough to outweigh concerns about adding something sugary, which can promote the growth of the bad bacteria. I would only use zantac if the bunny weren't eating at all, needed metacam, and there wasn't another pain med that was acceptable (that didn't cause stomach issues). My approach to GI slowdown is fiber (hay, pumpkin, critical care), water (sub-q, veggies, oral, pedialyte), probiotics (critical care, benebac). Add simethicone if gassy noises are present in the gut. If these are not enough, add pain meds--non-NSAID if there's absolutely nothing in the belly. If that's not enough, add gut motility drugs if the rest doesn't solve the problem (and you're sure there's no physical gut obstruction). For a tilt, antibiotic, pain meds, and anti-seasickness meds are important. So, it may sound like a lot of meds, but most are a good idea. I would go ahead and treat the tilt, preferably with injectible antibiotics, while continuing the GI treatment. You may also consider a nebulizer with saline or antibiotic to reduce lung congestion if a lower respiratory infection is also suspected. It can take weeks for a bunny to get completely over a GI stasis event, plus he's probably not really willing to eat with the tilt and possible respiratory infection.

 

[molly]

I'm having a lot of issues with his skin right now. It was always tough and leathery but it seems to be worsening and now his fluids leak out when I pull out the syringe. We're going for a recheck tomorrow but until then I'm supposed to keep injections to a minimum.

Isn't ranitidine an antacid?

The lactulose has been beneficial to Taco. He'd been producing approx. 20-30 stools per day at the hospital and it went up to over 100-150/day once I started the lactulose. He still has a huge impaction in his cecum that needs to be broken up somehow.

I've tried pumpkin with him but he really didn't like it and he spit out a lot of his force feed. I'll pick up a new can and try again now that he's feeling better though.

He is eating on his own, not a lot (1-1.5 tbsp. of pellets, a couple leaves or lettuce and small amounts of hay) but it's slowly increasing.

His congestion is almost gone so I think the antibiotics he's on now are working. If there's nothing wrong with his skin, I don't know if I want to chance switching them again seeing as he improved. I know I will not be able to get more injectable Baytril, he was on it for 8 days already and the longer he gets it, the more likely he is to get a skin reaction. I guess I could do Pen G plus Doxy, I just worry he will get worse again and he won't be strong enough to fight back.

I have a nebulizer (particle size .5-5 microns) but I think the congestion was nasal and it's improved. The thing I hate about my nebulizer is that it's about as loud as a lawn mower and usually stresses really sick animals even more.

Back to the vet in the morning and we I'll see what he says. I'm interested in his opinion on whether or not his cecum has improved, that will tell me a lot about his progress.

 

[molly]

Back from the vet...

He was really happy with his progress. The most pressing issues were concerns about his skin reacting to too many injections and that seems to be ok but I'm supposed to avoid injections as much as possible. He drinks a lot on his own and he's eating more and more veggies so it's only fluids by mouth for now and we'll see how that goes.

The vet took a stool sample and is going to get back to me regarding the results. I think he's suspecting some sort of yeast infection that's contributing to his GI issues but he wants to look into it a bit more. His cecum feels full but no longer rock hard (!), which is very encouraging. Before, he wasn't sure whether he would survive or not but he seemed a lot more positive/hopeful today.

 

[tonyshuman]

Ranitidine is zantac, which is an antacid. It reduces the acidity of the stomach and is sometimes given with meds that might cause stomach bleeding, like metacam. If the bunny has food in the stomach and the duration of the treatment with metacam etc isn't too long, it shouldn't be needed.

Glad he's improving. I agree that nebulizers are a noisy pain. I was just trying to think of any way to treat a respiratory infection without upsetting the GI tract, and inhalation of antibiotics is an alternate route other than injection if he was getting too many injections. Baytril injectible is known to cause sterile abscesses at the injection site, so be on the lookout for that. PenG/Doxy would also have to be injected. You might ask the vet to show you another injection site--you're probably doing it all sub-q at the nape of the neck, right? There are other places you can inject sub-q, it's just a little bit harder.

 

[molly]

After I wrote the last post, I went to feed him and he had diarrhea. I tried to get it under control and got him somewhat stabilized but he just shut down this afternoon. The vet thinks he triggered his bowels emptying themselves out when he did a deep palpation at the exam. He literally lost 100 g (he originally weighed less than 1 kg when I adopted him) in less than two hours. He was doing so much better, I really had hoped he would recover.

I know the azithromycin and perhaps the oral Baytril triggered his latest round of GI issues. I now know he actually had intermittent diarrhea (not excess cecotropes) since I started the zithro and a yeast infection developed at some point. I can't believe I missed it, he would eat them, had normal stools plus occasional dry/misshapen ones and he improved so much it just didn't fit my expectations of what diarrhea should be.

I'm kicking myself for not insisting on injectable antibiotics. The first vet hospital he was in refused to give me any injectable Baytril to give at home (even though they dispensed Pen G) and I didn't think we'd be able to get him past the stasis if he couldn't eat on his own, which wouldn't happen if his ear infection weren't aggressively treated. The congestion, although it bothered me, was not significant to his overall condition. I have two rabbits with Cilia Associated Respiratory Bacillus and they often have nasal congestion but I only treat it when it's persistent or severe enough they have secretions but there was something about Taco's congestion that made me uncomfortable even though it wasn't severe. In fact, when I booked his initial exam I told the vet I wasn't worried so much about his respiratory infection but of an ear infection associated with it.

Azithromycin was his best chance to beat the ear infection and since the vet was reluctant to allow me to give injectable Baytril for much longer (due to risk of tissue necrosis) that only left me with injectable Doxy and Pen G if I didn't go oral. I didn't even think of Gentamicin but I don't know how effective it is on ear infections. The flip side is that if we didn't get the otitis under control, it could have gone to his brain and killed him anyway. I've had it happen with rats and it's not a peaceful way to go.

I'm really mad at myself for not being more worried about the soft stools. He was improving so much despite the GI issues and he did have more and more normal fecal droppings each day so I really thought it was not so serious. Ironically, I think he would be fine still if I had not taken him to the vet.

I'm taking him in for a necropsy tomorrow, I don't know if I'm going to pay for a full histopathology yet but at least it'll give us a better idea of what happened.

I feel terrible about everything. I know he would have died had he become ill at the shelter but it's little comfort. I don't think I can handle adopting another rabbit for Chantale... I feel bad she will be alone but I cannot handle the maintenance involved with rabbits when they get ill.

 

[tonyshuman]

I'm so sorry. It was not your fault; it is harder to pick up on illnesses in a bunny you haven't had for as long. The stress of the neuter probably caused some low-lying infection to become serious and GI issues piled upon each other quickly. I have a hard time telling the difference between cecals and diarrhea--what has worked best for me is smell. I know it's really gross but cecals smell kind of oniony and diarrhea usually smells more fecal-y, like a latrine. Rabbits can be very sensitive. If he was having diarrhea, the cisapride could have made that worse. It's really unfortunate but sometimes rabbits just can't handle the stress of going through a surgery and moving to a new home. I'm so sorry.

 

[SnowyShiloh]

I'm so sorry about your poor Taco It sounds like you took excellent care of him. Please don't blame yourself for his death, you did everything you could.

 

[molly]

The diarrhea didn't smell at all, that's what threw me off. I had a bunny that died after she developed enteritis following a fire alarm (she had also been battling a chronic ear infection for months and had some GI issues) and when she had diarrhea it was completely different. It smelled awful and was super liquidy, this wasn't.

I didn't know Cisapride was contraindicated for diarrhea and I kept on giving it when he was declining. I'll never know if it would have made a difference to switch to Trimebutine.

The vet did a necro yesterday and called me with the results. He had no signs of an ear infection, meaning he never had one or it had completely cleared up. (The vet thinks it cleared up and I agree.) He kept some tissue samples to look at for EC but he really doubts he had it. I can't remember how he explained it but he concluded he died from the diarrhea but didn't think he had enterotoxemia. He was very concerned about a thickened intestine wall because of the palpitations (his abdomen always felt strange) but there were no abnormalities in that regard.

He was doing so well (and his GI troubles were clearing up) when I took him to the vet on Saturday. I really think the palpation and the stress of the vet visit is what tipped him over the edge and I feel so guilty about that. I didn't know if he would make it when I brought him home from the vet but late last week, he really seemed to turn the corner and I really thought he would make it. I'm so sad, I wish people would give more details about their animals when they surrendered them to shelters. If I had known he had a history of snuffles or that he ate lots of veggies or hay, I may have pushed the vet harder to start antibiotics right away BEFORE he got the head tilt.