Recurring Head Tilt

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JBun

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If there's not any improvement after 15 days, you likely won't see any and euthanasia is probably the kindest thing.

Though if you aren't seeing any improvement and you're faced with that decision, you may want to consider giving the azithromycin a try 30-50mg/kg, once a day). If it's going to work at all, it will happen pretty quickly. Significant improvement in 3-4 days is my experience with it. My rabbits ended up having to be on the higher dose of 50mg/kg and for an extended length of time, but it knocked the infection down very quickly and cleared it up completely after the course was completed.

If your rabbit is deteriorating significantly, you may want to consider giving it a try sooner rather than later. Even though there are more side effect risks with its use, at some point it becomes worth the risk to me.
 

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If there's not any improvement after 15 days, you likely won't see any and euthanasia is probably the kindest thing.

Though if you aren't seeing any improvement and you're faced with that decision, you may want to consider giving the azithromycin a try 30-50mg/kg, once a day). If it's going to work at all, it will happen pretty quickly. Significant improvement in 3-4 days is my experience with it. My rabbits ended up having to be on the higher dose of 50mg/kg and for an extended length of time, but it knocked the infection down very quickly and cleared it up completely after the course was completed.

If your rabbit is deteriorating significantly, you may want to consider giving it a try sooner rather than later. Even though there are more side effect risks with its use, at some point it becomes worth the risk to me.
i brought it up multiple times to the vets on our visits, but they seemed reluctant to prescribe it. i can call the third vet tomorrow and ask him if he would consider it. i hope that it wouldn't cause more suffering than what he's already going through if he got side effects?
 

JBun

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You could give the baytril and panacur another week, if your rabbit isn't continuing to get worse in this time. But at least for me, if there wasn't some improvement after one more week, switching to azithromycin would be a serious consideration for me, as a last ditch effort.

If you do decide to try it and a vet will prescribe it, which I can't see why it would be an issue if the alternative is euthanizing, then the best pricing for it is to get a prescription for the 15 or 30ml bottle of 200mg/5ml suspension, called into a pharmacy to pick up. Costco ended up being the best price for me, using a goodrx coupon code, and making sure they had it or could get it in quickly. The bottle when mixed, is only good for 2 weeks, so the vet shouldn't prescribe more than is needed for that amount of time, based on the size your rabbit is and amount needed. Also when giving it, make sure to give with food and fluids to try to minimize the stomach upset and cramping that can occur.

I really hope you can find a solution and treatment that starts working for your bun. I know how difficult and stressful it is to have a critically ill rabbit.
 

JBun

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There is the potential it can cause stomach upset. It's not common, but can happen. But if it does happen, stopping the meds will usually stop the upset too. The most I saw was temporary stomach cramping, that went away after 3-4 hours and my rabbits were fine after that. But if you're concerned, certainly save it as a last option if nothing else is working and you're faced with the decision to euthanize.
 

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There is the potential it can cause stomach upset. It's not common, but can happen. But if it does happen, stopping the meds will usually stop the upset too. The most I saw was temporary stomach cramping, that went away after 3-4 hours and my rabbits were fine after that. But if you're concerned, certainly save it as a last option if nothing else is working and you're faced with the decision to euthanize.
thats the main concern id have with it and why the vets seemed reluctant to prescribe it. if it hurts him really bad i dont want his last moments to be that sort of agony. i do want to consider it though because it's hard to see things getting better when he's like this. he's only had one dose of the panacur though.
 

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spoke with the vet the other day and he said he wouldnt prescribe azithromycin without first seeing how the panacur does after 30 days. but i didnt want to make jojo wait a whole month for that while lying on his side and miserable.

the good news is today jojo figured out how to stand up, and even walked a few feet (across the little rolled blanket barrier i'd set up to keep him from hurting himself) over to me and woke me up to show me what he'd done. needless to say im cautiously optimistic now in a way that i was not before. whether its the baytril or the panacur, i hope that its working.
jojo seems chuffed to be off of his side and looking around, even if he is still significantly tilted and can't stand back on his back legs to wash himself just yet.
 

JBun

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That's wonderful to hear! And so sweet that he came to you to show you 🥰 I'm really glad you're seeing some improvement with him.
 

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That's wonderful to hear! And so sweet that he came to you to show you 🥰 I'm really glad you're seeing some improvement with him.
thank you and im still very scared that he could take a bad turn again but for now its just good to see him feeling a bit better. have to appreciate the little things while he's still here after all :)

jojo is a huge sweetheart, he never ceases to amaze me
 

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while his condition remains mainly the same, i am a bit concerned that he has stopped pooping, even though i have been feeding him critical care. i think i will call the vet tomorrow since this worries me, it might be a blockage or something and i ran out of his meclizine anyway. is there a chance any of his meds would call this or is this usual for a head tilt infection? even in previous times he was sick, he would still poop as long as there was food going through him.

in light of that and the general uncertainty around these conditions, i am still unsure of his prognosis, if he will get better or worse. if it gets worse, i have to be prepared for that emotionally. if he gets better....how long will it take? there's no telling since from what ive read it can take anywhere from weeks to months. and that is another problem...i am running dry on my savings and jobless, so i need to get a job if i want to continue affording his vet bills. but if he needs long term care, how will i be able to hold a job and administer the medication and food he needs every 6 hours? ive already been turning down opportunities to go out for just a few hours because i don't see myself getting enough time to feed him on time. its very time consuming to do so because he can only take a little bit at once and he struggles so much. i don't have anyone else around who can reliably do it for me as the only other people i know with the free time are too ill/elderly to wrangle him. the small beacon of hope i have in his recovery gives rise to fears about this and im not sure what to do. can his feeding/medication times be adjusted? i seriously doubt he can take bigger quantities of critical care and water in one sitting.
it's fortunate that i didn't have any prior obligations when his illness came about, but now i am wondering how the heck people with jobs care for their sick rabbits. does anyone have insight?
 

JBun

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Narcotic pain meds can cause a gut slowdown(constipation), but not usually meloxicam and baytril. It's possible the panacur could be contributing to that. If he's not currently on a gut stimulant(eg. metoclopramide, cisapride), you could ask your vet about that to help with his gut motility. The benefit from that can be an increased appetite, which would help with the amounts he'll eat. Also make sure he's getting enough fluids with the critical care. If you give a thicker mix, then you'll need to give more water separately. Too dry a mix will mean not enough water to balance it out, which would result in a slower gut.

It's common for there to be a sudden worsening of symptoms just prior to things starting to improve, so hopefully this is where you're at and you'll see that gradual improvement over the next week or two. Once that improvement starts happening, things seem to get a lot better after that. But this is just generally, and improvement will vary in each individual case.

It is very difficult and very time consuming. I had an old rabbit that had hind limb paresis, and I had to check on her and help her every 4 hours, including night, for several months until she passed. It pretty much took up my whole life for those months, but luckily I had the time and was in a position to be able to do it. Not every one can or is able to. You just have to do the best you can in your given circumstances and with your given finances, and not kill yourself trying to do more than you're able. And sometimes that may mean pts for the good of the bun, if the level of care needed isn't possible for someone to do.

If switching to doing meds and feedings every 8 hours is what would work best for you to be able to do the things that are necessary for your life right now, I would say do it. It's not ideal, but nothing about these situations is ever ideal.

One thing that can help to reduce costs if you need that, is to order meds online for ones you don't need immediately. So if you have refills coming up, you can request this from your vet. Pick an online company, make sure to give enough time it will be delivered in time for when you need it, fill out the info and order it, then they call your vet to have it approved. This will usually reduce med costs by half or more. I've even gone the route of getting tablets instead of a suspension, crushing them and mixing with something sweet(eg. juice, jelly, maple syrup) to then give to my rabbit, because the tablets are sooo much cheaper. Baytril is one that you can do this with.

So those are just some things that worked for me when having to manage caring for a critically ill rabbit.
 

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jojo's tilt is improving quite a lot. his head tilt is a lot less visibly pronounced and his eyes stopped rolling in his head. he still is having balance issues but im hoping that will clear up with time and treatment. right now the big issue is that the medications caused him gi stasis so hes being treated for that too. hopefully he will eat more on his own eventually and i will be able to scale back the amount of times per day i have to force things down his throat.

we figured something out with the living situation that will temporarily hold me over while jojo is being treated.
 

JBun

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Wow! Improvement that fast isn't the usual. You must be so glad! 🥰 As the vertigo from the head tilt subsides, that may help with his appetite. It's got to be very disorienting for a rabbit, when their head is twisted nearly upside down.
 

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Wow! Improvement that fast isn't the usual. You must be so glad! 🥰 As the vertigo from the head tilt subsides, that may help with his appetite. It's got to be very disorienting for a rabbit, when their head is twisted nearly upside down.
the past two times he had head tilt, it didnt actually get this bad and it cleared up in two weeks. this time i am not taking any chances and i will keep him on the baytril for the full month even if his symptoms subside. i have no idea what the cause was before but if its just lingering e. cuniculi then there is very well a chance it could just happen again and again...

the vet didnt prescribe him more meclizine last time, so i wonder if he is still experiencing the vertigo. his head is just at a slight tilt, almost entirely upright so it is easy to miss until you see him moving around. he has a tendency to circle towards his left (his tilt is to the right) but he can move in the other direction if he wants to, and he is a little wobbly on his feet.

i really hope his appetite improves, it feels like he is getting stronger at fighting me when i force feed him, but he has gotten so bony. his poops are tiny but relatively consistent, so i know things are kinda moving along but not where they should be.
 

JBun

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Usually the antibiotic should be continued 2 weeks past the last of the symptoms clearing up(excluding those left from permanent cell damage). So if you need to extend the antibiotics longer to do this, I would suggest bringing this up with your vet. You just don't want to stop the antibiotic too soon and risk the infection not having cleared up completely. I would probably want to add another 2-4 weeks to be safe. Though this might not be possible for you if it continues to cause a lack of appetite for your bun.

Sometimes a rabbit will be left with a residual head tilt from permanent cell damage that's occurred. Often they can learn to cope just fine with this.. And having it doesn't mean the rabbit is still sick.

Will he not eat pellets, hay, or veggies on his own at all?
 

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Usually the antibiotic should be continued 2 weeks past the last of the symptoms clearing up(excluding those left from permanent cell damage). So if you need to extend the antibiotics longer to do this, I would suggest bringing this up with your vet. You just don't want to stop the antibiotic too soon and risk the infection not having cleared up completely. I would probably want to add another 2-4 weeks to be safe. Though this might not be possible for you if it continues to cause a lack of appetite for your bun.

Sometimes a rabbit will be left with a residual head tilt from permanent cell damage that's occurred. Often they can learn to cope just fine with this.. And having it doesn't mean the rabbit is still sick.

Will he not eat pellets, hay, or veggies on his own at all?
he has started nibbling the leaves off of cilantro, just not with his usual enthusiasm so i dont think its enough to keep him fed. i figured i would back off the critical care when it looks like he doesnt need help eating and his poops are back to normal.
 

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so its been a little bit, he is pooping more consistently but im kind of worried about the state of his poop right now. he does do his regular poops but theyre still very tiny. he has been doing a lot of cecotropes though and i am not sure what this means. the vet recommended some leafy greens to get him to eat, so ive mostly gotten him romaine and a few dark green lettuces like that and supplied him with some handfuls of that every now and then. ive also been giving him critical care but letting him eat it on his own now that he has gotten some of his appetite back. he still doesn't eat much of his hay.

the vet was super unhelpful about this. she seemed to think everything was fine but i am inclined to take what she said with a grain of salt because she also thought pineapple juice was going to help his stasis and told me not to do any research online when i brought up how multiple sites recommend against this because there's too much sugar in it and the enzymes have a negligible impact on digestion. maybe what she said about leafy greens was also unhelpful but i figured if he had options that were palatable to him it would at least get his guts moving again.

ive still taken jojo there because i dont exactly have many choices for rabbit veterinarian in my area.

i could go back to force feeding him critical care to ensure he gets a lot more of it in his system, even if it's difficult. i am just not sure if i should give him more or less of what i am giving him right now.
 

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the poop is starting to look like diarrhea despite taking the fresh greens away and giving him just hay, water, and critical care. im wondering if the baytril is the cause at this point. will have to call a vet tomorrow and hope there is an opening...
 

JBun

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If there are still normal round fecal balls being produced, the mushy poop is likely mushy cecotropes, and could be from the antibiotics. If all of the poop is mushy, your rabbit could have developed antibiotic induced diarrhea, and that is an emergency, which you should contact your vet immediately.
 

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If there are still normal round fecal balls being produced, the mushy poop is likely mushy cecotropes, and could be from the antibiotics. If all of the poop is mushy, your rabbit could have developed antibiotic induced diarrhea, and that is an emergency, which you should contact your vet immediately.
it went from mushy cecotropes to actual diarrhea. i will be calling a vet in the morning, right now it is 4am so no one is open. should i make him drink some water in the meantime?
 

JBun

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I would first stop all meds until you get to the vet, especially the baytril. I've read of people giving koalin or activated charcoal to bind the bacterial toxins, but it's not the usual recommendation, and it's not something I've ever tried, so I can't say if it's something I would do or not.

The most important thing is the vet getting your rabbit started on cholestyramin(Questran) right away, to protect the digestive tract from the toxins released by the pathogenic bacteria. Then the antibiotic metronidazole is usually given to counteract the harmful bacteria.


This is pretty serious if your rabbit really does have true diarrhea, so just get your rabbit to the vet as soon as possible.
 

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