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My inexpereinced vet said our hotot has an inner ear issue - he has a severe head tilt. Looking for advice.

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Katsuko88

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I'm currently undergoing health treatment away from home and neighbors with a lot of rabbit experience are bunny sitting my rabbits (I've got a couple), including my male Hotot, Dewey. But a couple days ago, Dewey began moving with a pronounced tilt to his head. My neighbor was able to take him to our vet today - she's the only vet in the area that will treat rabbits but she definitely can't be called an expert and will will often go off and look things up on the internet - she's admitted as much to me. So my confidence in her his unfortunately limited. Dewey's appointment was just before closing time and some badly timed circumstances on my side prevented me from being able to join on a phone call with the vet at the time, but my neighbors passed on as much info as they could. I'll speak with the vet tomorrow but I was hoping to get some info from the wider community on others' experiences and advice based on what I know so far.

When this vet saw Dewey, she was able confirm he didn't have ear mites or a major noticeable ear infection. She said he is experiencing an inner ear issue but wasn't able to determine the cause.

She's suggested two medications: Baytril Tablets, and Metacam. But also she said that while it might help the head tilt a little, she didn't think it would help a lot...and from the pictures I've seen that looks to be near 90 degrees at this point..his ear is practically resting on his shoulder....my poor baby just LOOKS so uncomfortable!

Our neighbors say Dewey is able to eat and even groom himself but is struggling with drinking; he's able to manage it with difficulty with a bottle that lets a lot of water out but they said the water gets in his eye... the medicine MIGHT help enough that he'd be able to manage better...

This couldn't have happened at a worse time. My own medical issues mean I won't be home for at LEAST another week. The neighbor is willing to help until then but I'm not sure how much time I'll be able to dedicate to poor Dewey once I do get home, at least for a while until I'm back at full strength. I'm not sure what I should do. I've no idea what the quality of life would be for Dewey going forward - I'm guessing he'll require special care after this and at this time I'm not sure how able I'd be to give it. And, as much as I hate to admit it, cost is also a big issue right now. The medicine the vet suggested will cost around another $100 on top of the visit fees I already paid....and she's not even sure if it will do anything.

This one of the pictures I was sent. It's of him drinking. His head is constantly at this angle - if not a little worse as it might be propped a bit by the wall here. The picture of him lying down I got was heartbreaking.....and I just can't bring myself to share it. 😭
1603259920569.png



I'm very torn on what the best course of action should be and really appreciate anyone who has advice or past experience with such a thing.
 
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JBun

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There are two common causes of head tilt in rabbits. An inner/middle ear infection and the parasite e. cuniculi. Ear mites can be a contributor in minor cases, but aren't considered a primary cause of moderate to severe head tilt in rabbits. If your vet didn't do xrays to confirm an inner ear infection as the cause, then e. cuniculi is also a possibility. When it can't be definitively diagnosed as one or the other(which can be difficult as tests aren't always conclusive), most rabbit vets will treat for both possibilities with antibiotics to cover a possible ear infection, fenbendazole(Panacur, Safeguard) to cover the possibility of e. cuniculi, and the anti inflammatory meloxicam/metacam to reduce the inflammation that is caused by both diseases. In severe cases corticosteroids may be used, but at some risk as it affects the immune system and usually is only used as a last resort in extreme circumstances.
Medirabbit (inner ear infection in rabbits)
Medirabbit (signs of e. cuniculi)

Your buns head tilt is pretty severe. At this point if you are inclined to try and treat, I would want to go at it aggressively. That means possibly doing a corticosteroid injection instead of the metacam. It's more risky as it can compromise the immune system, but it will more immediately reduce the inflammation that is contributing to the head being tilted, and potential permanent cell damage that can occur because of prolonged inflammation which can result in permanent head tilt even after being cured. But corticosteroids are very risky in rabbits, so if you aren't inclined to want to risk using them, or your vet won't risk it, then meloxicam/metacam is usually what is used. Though I would initially want to be giving the higher dose(0.6mg/kg, twice a day) for the first week, to get on top of the inflammation as quickly as possible. Usual dosage for rabbits is 0.3-0.6mg/kg, twice a day.

The next thing is the antibiotic. Baytril isn't necessarily bound to be the most effective. It could work but often doesn't seem to. I would be more inclined to try azithromycin which has shown to have good results and quickly, when it comes to ear infections in rabbits, because of good tissue penetration. There are some good success stories of head tilt buns recovering with azithromycin being used. The cheapest option I've found is for the vet to call in, or write the prescription for you to take in, for a liquid suspension for people, 200mg/5ml. I got mine at walmart using goodrx, $23 for 60ml. Dosage for rabbits is 50mg/kg once a day. A lower dose can be used, but I had problems with infections returning at the lower dose. A 1kg hotot would need about 1.2ml per day, and my rabbits got this a minimum of 2 weeks. A 30ml bottle would be plenty for your bun, so cost would be less than $15. The main thing to be aware of with azithromycin, is that in some rare instances some rabbits can have a very severe digestive reaction to it, in which case it should not be used. I didn't have that issue with my rabbits though. At the most there was some abdominal cramping and reduced appetite, that subsided after a few days.
Headtilt experiences | OnTheWonk.co.uk (head tilt experiences and using azithromycin to treat)

Then there is covering the possibility of the head tilt being caused by e. cuniculi. Usual treatment is with Panacur (fenbendazole ), 20mg/kg once a day for a month. Not sure what your vet would charge for that, but if it's more than $30, I would just buy my own. It's a different brand sold as Safeguard goat dewormer 125ml bottle (but pretty much the same thing as Panacur) for about $30 on amazon, or from most farm supply stores if you have one nearby.

Then there is syringe feeding of Oxbow critical care(apple banana) feeding mix if your bun isn't eating well on his own. You can get some initially from the vet, or order from amazon is cheaper, then just make a pellet slurry until the order arrives. Or the people caring for your bun.

This is a very labor intensive illness to deal with. And because of your situation, you'll need to determine if treatment is even going to be possible at this stage. If the carers are willing and able to do this, and you decide to try treatment, here are some more links with info on dealing with head tilt buns and how to help care for them that could prove helpful. One is a facebook group of other owners that have dealt with the head tilt issue.

Hopefully I covered it all. This is a complex illness, and there's a lot of information to go over. I've included reliable medical based links with the information on treatment and drug dosages in case you need to back up anything in approaching your vet.
 
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JBun

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You're welcome. Slight correction for the azithromycin, it's 200mg/per 5ml.
 

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