Sammi & balance issues/front leg partial paralysis.

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kherrmann3

kherrmann3

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Yesterday, I took Sammi to the vet. I had her out for playtime, and I noticed that she was losing her balance more than before. I don't think I posted it here, but she had some "minor" balance issues from earlier in fall. I don't remember when, exactly, but it has been going on since late August (at the earliest).

To make a long story short: She had been running around for her playtime in the bedroom and Toby got out somehow. When I went into the room (for whatever random reason) I saw Toby out. I hurried and got Toby back to his cage. Then, Sammi hopped out from under the bed and fell over. I checked and double-checked both of them for bites, scratches or hunks of skin missing. Nothing on either of them. Sammi just kept falling over like she was drunk. I called Will at work (I was hysterical with guilt at this point) and he said he would check her out when he got home. When he got home, she wasn't doing it as much anymore. Being that she is his bunny, it was his call as to what to do. He wanted to leave her alone and see how she was in the morning. She still would fall over on occasion, but overall she was doing well. She was bright-eyed and bushy-tailed and still ate, drank, and used the litter box just fine.

A little after that, I had her out for run time in the apartment. This would have been around November 9-11. She would hop around, then list to the side and fall. It was like a "plopping" motion, but she would do it while she was mid-run. She would thrash around to right herself, and then she would be fine.

Getting back to yesterday, I took her out for some run time, and she fell over more-frequently than she did the last time. I couldn't get a hold of Will while he was at work, so I did what any good bunny co-parent would do: Skipped out of a study group and took her to the vet. The vet that was available isn't an exotics specialist, per se, but he does see rabbits (and he's the owner of the clinic). Sammi was probably 75% worse at the vet. I don't know how it happened, but she wasn't hopping anymore. She just scooted herself around with her back legs. He looked in her ears, and they were fine. He could see her tympanum (eardrum) OK, and they were not inflamed. He checked for nystagmus (involuntary eye movement) by rolling her on her side and watching her eyes while she was lying and once she righted herself. She had no recent history (or any history of) nasal discharge or weepy eyes (minus the corneal ulcers that she had). So, other than the balance issues, she has been healthy. He said that it didn't sound like E. cuniculi, head-tilt, or an ear infection based on the exam. To him, it looked more like a spinal cord injury.

Being that she is almost seven, I did not want to do any more testing, for the moment. He was kind enough to prescribe some Baytril and Panacur for her. I am supposed to give her both of those twice a day for two weeks. If symptoms improve, he will give us a refill to finish the full course of the antibiotics/dewormers. I am also supposed to give her Metacam twice a day. Her dosages are as follows:

Baytril: 1.0ml (15mg/ml suspension) \
Panacur: 0.3ml (100mg/ml suspension) ---> All medications are twice a day.
Metacam: 0.3ml (1.5mg/ml suspension) *** /

*** I had leftover Metacam from before, and the suspension is probably different than the one that this vet would have prescribed. I am following the dose that is on the old bottle, which is 0.17ml.

Luckily, she likes the flavoring of all three medications, so I just have to put it on her evening salad. I don't think she would eat soggy pellets, so now she gets a little piece of lettuce in the morning instead of just the pellets.

As of right now, it looks like her front legs are not really working. Her back legs work fine, and she can "hop" with them, but the front legs do not work well. She can hold weight on them, groom with them, and hop into her little box, but she can't hop in a line with them, if that makes sense. The toes on her left front paw are somewhat contracted into a little "bunny fist". When at rest on a smooth surface, her front legs slide away from her. She sticks her right front leg out straight in front of her, but she keeps the left closer. When she falls, it is usually to her right. I've seen her fall both ways, but 90% of the time, it's towards the right. I will try to post more videos to let you guys get a better feel for what is happening.

Will and I are shopping for things to make her cage more "handicap-friendly" tonight, so we will be picking up some of that lambswool-like fleece to pad her cage with (mostly around the wire pen so she doesn't fall and hurt her eye or head) as well as a lower litter box. We are also planning on moving her cage around so it is not as long and narrow. If she's having mobility issues, I would think a pen with a more evenly-distributed floor plan would be better. (Example: Instead of a 2-4 NIC panel pen, a 3x3 panel pen.) That way, there would be less turning around to get to things. If anyone has any other ideas as to how to fix-up a bunny pen for a rabbit with mobility issues, I would love to read about them!

Here is that video I mentioned before. This is the kind of loss-of-balance that she has. Unfortunately, it's worse now (her front feet are not working as well as they did in this video). I will try to get more video later to show how she's moving now.


Any ideas?

Thanks in advance!
 
Poor little precious. I meant to comment on your blog about it but hadn't had time to think in detail about what might be going on.

Often a balance issue can get worse with stress, which is probably why she was worse at the vet.

Did they do an x-ray on her? With the front leg problems I wonder if a pinched nerve in the spinal cord might be happening, or maybe some kind of issue with the very deep inner ear structures. Those inner ear structures could be located close to the motor areas of the brain that control the forelimbs, and if a big infection or some trauma were there, it could explain the combo of loss of balance and leg problems.

Are you sure that the loss of balance isn't just her not being able to use her front legs properly? In the videos, and from your description of how she moves, it seems like she only falls over because she's expecting her front legs to hold her up in a certain situation and they just aren't working correctly.

She could have run into something and hit her head or spine causing trauma, which is another reason to get an x-ray. The left toes thing you describe sounds a lot like bunny arthritis, which can also affect the spine and cause bone spurs to grow, which can pinch nerves and such.
 
tonyshuman wrote:

Often a balance issue can get worse with stress, which is probably why she was worse at the vet.
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That's what I thought. I figured that the stress (and disorientation) of the car ride could have done it. I hate how they look so much worse when they are at the vet. It makes me feel like a negligent bunny parent when the vet is examining this poor, weak, and in this case - wobbly, bunny. :(

Did they do an x-ray on her? With the front leg problems I wonder if a pinched nerve in the spinal cord might be happening, or maybe some kind of issue with the very deep inner ear structures. Those inner ear structures could be located close to the motor areas of the brain that control the forelimbs, and if a big infection or some trauma were there, it could explain the combo of loss of balance and leg problems.
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No, I didn't consent for x-rays... Yet. I figured that because she's almost 7, and I don't have the funding that I normally would if I was still working, that we would wait on the x-rays. We are going to see if her balance is bacterial or a worm of some sort by treating with the antibiotics/dewormer. If her symptoms improve, we will continue the treatment, if not, we know it's spinal/neural. Unfortunately, I don't see much of a point in diagnosing what is exactly wrong with her spine (if that's the case), because I can't see myself putting her through any surgery (if it's bone related or something like that).

Are you sure that the loss of balance isn't just her not being able to use her front legs properly? In the videos, and from your description of how she moves, it seems like she only falls over because she's expecting her front legs to hold her up in a certain situation and they just aren't working correctly.
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She falls when she's running, too. It's hard to tell why she falls sometimes, because they move so fast. It normally seems like her rump falls to the side. I see her falling a lot when she turns, too.

She could have run into something and hit her head or spine causing trauma, which is another reason to get an x-ray. The left toes thing you describe sounds a lot like bunny arthritis, which can also affect the spine and cause bone spurs to grow, which can pinch nerves and such.
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I'm thinking that's what may have happened. She used to run around like a speed-demon, and I think she may have run into a box or something under the bed (they're right behind the bedskirt, so if she was running to get under the bed, she may have rammed right into it).

Thank you for the replies, both of you. :)
 
That is a good point--what you're doing for her is what you'd do for a spinal injury as well--giving the anti-inflammatory meds (metacam). If the antibiotics and antiparasitic don't help, I would just consider her a special needs bunny suffering from some arthritis.
 
Yeah, that's pretty much where we are with the situation. Will and I have decided that if she doesn't get better, we aren't going to put her down unless it's on her terms. If she still shows interest in food and her surroundings (basically, bright-eyed and bushy-tailed), then we will give her the benefit of the doubt and let her be. If she stops enjoying her food, looks listless all the time, etc., then we'll know it's time. We are going to fix-up her cage soon, too. She is still able to get around OK in the set-up she has (it's all one level), so we aren't super-pressed to do it ASAP.

It seems like it gets better and worse. Yesterday, Will saw her hopping normally in her cage, but when I watched her eat some hay last night, she would stretch for the hay (stretch a little in front of her) then pull back to eat the hay. She was kind of wobbling from side-to-side when she would pull back (like she was trying to balance). When I was petting her, she plopped over on her side (I accidentally petted her "too hard" and knocked her off balance). I think we're just going to have to see how it goes.
 
Aw good luck with her. She reminds me a lot of my Berry. She had front end paralysis after her stroke at the beginning of this year - it mostly effected her front legs and for awhile her shoulder/neck muscles. The poor dear couldn't even lift up her own head for awhile. She slowly made improvements - now, almost a year later, she's improved so much! The only problems she has now, is her front legs are still a bit wobbly. It worse on one side than the other. Once in awhile she'll loose her balance and fall over a bit. She's also blind in one eye. But otherwise she's a happy, healthy bunny who is still clearly enjoying life.
 
Dragonrain wrote:
Aw good luck with her. She reminds me a lot of my Berry. She had front end paralysis after her stroke at the beginning of this year - it mostly effected her front legs and for awhile her shoulder/neck muscles. The poor dear couldn't even lift up her own head for awhile. She slowly made improvements - now, almost a year later, she's improved so much! The only problems she has now, is her front legs are still a bit wobbly. It worse on one side than the other. Once in awhile she'll loose her balance and fall over a bit. She's also blind in one eye. But otherwise she's a happy, healthy bunny who is still clearly enjoying life.
Click to expand...
I also wondered while reading this if this could be a serie of strokes :?
 
Well, as of this morning, she's not doing very well. Will fed the rabbits their evening salads last night and went to bed. Sammi didn't eat it by this morning. I picked up the area she likes to hide under (expecting the worst), but she was there, just slumped over. She must have fallen overnight (or yesterday) and wasn't able to get back up. I picked her up and put her in the little pet bed in her cage. She drank a ton when I put the water bowl by her. I had to give her a butt bath, too, because she had soiled herself after I sat her in the litter box. I moved some stuff around in her cage and rolled up some towels to put along the bottom of the cage (in case she rolls over, she has something soft to fall on). I also rolled up some towels for some extra padding on the sides of the cage. I wish I knew what to do. She is eating hay and lettuce right now, and she is still trying to move. Am I just making her suffer by keeping her around?
 
I'm sorry.

It's hard to make a decision, I'm sure, without knowing exactly what is going on. When we found out Berry's paralysis was because of a stroke, we decided to take a 'wait and see' approach, because the vet told us that she wasn't in any pain and that there was a good chance that, with time, she would be able to gain back some of her mobility. Also Berry herself was a fighter and her attitude told me that she wasn't ready to give up yet. She still had a healthy appetite, and attempted to groom herself and eat on her own and all that despite her severely limited mobility.

When caring for Berry - she was at first restricted to a small plastic carrier. We lined it with blankets and hay and I fed and gave her water by hand every few hours, day and night. That was when she could barely move at all and couldn't get to her food/water on her own. After a few weeks, as she gained some mobility back, we moved her into a 1 story cage that I lined with blankets and pet beds and lots of soft stuff in case she fell over she wouldn't get hurt. We used a water bottle instead of a dish so she couldn't fall into her water, a very low entry litter box (I think they are made for senior rabbits?) and 4 times a day I hand fed her water and food (Just in case - but she was eating on her own at that point). Lots of butt baths and I gave her as much love and attention as I could. I think the most important thing at this stage is just keeping them as comfortable and happy as possible.
 
Oh I wanted to add...I think you said Sammi isn't that friendly? So this might be hard for you to do... But Berry's vet told us to give her 'bunny physical therapy" on her front legs to attempt to help her regain some muscle function.

Don't know if that would help you at all, because your bunny might not have the same problem Berry did...but it did seem to really help Berry. Twice a day I would hold her in my lap and very gently massage her muscles. I took her front legs, and gently manipulated them through all the motions that a normal bunny leg should be able to make. I worked maybe only 5 to 10 minutes on each leg twice a day, depending on Berry's mood. My vet showed me what to do, but it wasn't really hard at all or anything.

My vet said, that with Berry really not being able to move her front legs at all at that time, that the physical therapy would help keep her leg joints from getting stiff and her muscles from loosing too much mass, and may help reestablish connections with her legs and her brain. It's almost like how, with some human stroke victims, they have to learn how to walk all over again.

Maybe not helping in your case, since from the video you posted Sammi looks like she is able to move around way more than Berry could. Just figured I'd mention it, because it did seem to help us.
 
Thank you for the replies!

That video is outdated. She doesn't move her front legs at all. She has had to have two butt baths today. She just goes all over herself. She doesn't try to move much. I wonder if it's because she's hurting because she didn't take the metacam (on the salad)?
 
I'm so sorry, Kelly. This sounds really hard. I agree she might be peeing on herself because of the pain, but it's best not to give metacam on an empty stomach. I would keep her restricted to small area and line it with fleece, with puppy pads or paper towels underneath. That way the urine will wick away and not get her too wet.
 
Is there anything else for pain for bunnies? I am thinking of just treating her with palliative care from now on. How well does Metacam treat pain? What is Metacam equivalent to in people medicines? (Like, is it like Naproxen or other NSAIDS?)
 
Metacam /meloxicam would be equivalent to the NSAIDs which means thatit decreases inflammation and decreases pain.

When I read this thread I remembered a recent thread on Lara ( RIP) in which several members elaborated on other pain meds.

Iam attaching that thread as TF has used different meds in treating her special needs bunnies and this info is very valuable because there is experience behind it.

tramodol is oftenrecommmened for long term use , however , if the treatment is palliative then Metacam can also be used (if it is even effective in your case.) because the fear of kidney damage is secondary


Sammi is going to need very special 1:1 treatment right now to keep her comfortable and you are correct in attempting to determine whether she would benefit from another drug.


http://www.rabbitsonline.net/view_topic.php?id=61760&forum_id=16&highlight=pain+meds
 
I think metacam is good for her right now as it may decrease any inflammation, if she has swelling on the spine. She may need more pain help, though, on top of the metacam, like tramadol as angieluv said. We've been giving Benjamin metacam for inflammation in conjunction with nose issues, and it helped.
 
Thank you for your replies, everyone. It really helps to have a "support system" on here when I need it. Thank you so, so much. :hug:

I will be stopping over at my old apartment today (my old roommate still lives there). I left a few things behind for storage, and one of them is the Wabbitat-style cage I was given when we "adopted" Miss Emma McFluffybottoms from someone on Craigslist. I am going to pad the heck out of that thing and try to get it so it's more comfortable. I was also going to try to get her cage up higher (closer to the window so she can look out). It would also be easier to get to her if I need to. Any suggestions for padding a cage? I was going to put towels or pads over some pellet litter (to wick moisture other than the towels). I may or may not use the actual litter underneath... I haven't decided yet. Then, I bought some lambswool cloth and was going to roll it into little neck-pillow like ropes to line the bottom of the cage where it meets the wire "walls". That way, if she falls over near the metal, it's softer for her to land on. I also have to rummage around some boxes to find an old water bottle. I know I have some, I just can't remember which box it's in.
 
Some folks use fake sheepskin which is supposedly machine washable. Keeps buns dry and absorbs loads. But your current plan doesn't sound bad either. You're such a thoughtful mom.
 
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