Unresolved head tilt and constant rolling

[cmh9023]

Jessie has had head tilt since April 27. I’ve posted a few other questions about it and got some great information from several people. Thank you! So I thought I’d write an update in the hope that some people with head tilt experience will read it. Plus, I found it very helpful to search through old threads for information so maybe this will be of help to someone else at some point. I’m at work but don’t feel in the working mood so that’s why this will get long…

Her EC titer result came back as .615 which means she was exposed. But that was obviously no surprise. She still has had no blood test for infection. Not totally sure why, but my vet seems confident that it is not an infection. Based on everything I read no the forum I think it could be. I probably should insist on a blood panel, shouldn’t I? I let the vet know that Jessie had been treated for syphilis at the shelter. She had no signs but her babies had it so she was treated too. I asked if there could have been any residual infection from that or if syphilis could have travelled to her brain as it does in people. She upped her dose of PenG to what she said would be the treatment for syphilis.

The biggest issue continues to be the rolling. She can’t move an inch without rolling uncontrollably. Her head is still tilted at about 90 degrees. I read that people’s buns have done better outside of a penned area so I’ve tried that, but she can’t catch her balance at all. She’s been on meds (which I’ll list below) for 10 days.

At what point will I know that she won’t be able to stop rolling even with taking meds. If she is going to stop rolling should it have happened by now? If she could just regain her balance a bit and be able to move around a little I think she could have a very good life. But not being able to move without rolling uncontrollably seems like a horrible life. She does grunt and snort after a rolling episode like she’s totally irritated by it which makes me feel like she still has some spunk. The other sad thing is that she can’t live with her partner because if he bumps into her at all she rolls. She still tries to move. Not a lot but some. I’m thinking if she had lost her zest for life she wouldn’t even try to move. Is that wishful thinking?

This is her current medication:

.25 cc’s Oxybendazole (Once a day for 10 days now) Might Fenbendazole work better? I know Randy suggests Marquis. Has anyone else used that? Will my vet know what it is or how to administer it??
.25 cc’s PenG every other day (4 doses so far). Yesterday she added .5 cc’s every 7[suP]th[/suP] day in the event of syphilis infection (1 dose so far)

I’ve had an impossible time getting her to take the Meclizine so the pet pharmacist is going to compound and flavor it today. I’m hoping that might help with the rolling?

The other bad news is that she hasn’t pooped since sometime Saturday. (Just a few tiny ones, no cecals at all). I’ve been trying to get a much fluid to her as I can and I’ve taken her to the vet for fluids once since this started. She’s going again tomorrow for fluids and vitamins. So, she started taking Reglan and Ciscipride. I know most people will hate that, but I’m not sure what else to do. The rabbit vets at my clinic seem to believe in using it because they prescribe it very easily/often.

Appetite = Pretty good. Eats hay and some greens and a little oats. If she doesn’t take initiative to eat, I feed her piece by piece dipped in water and she will eat a fair amount.

Alertness = Up and down. She was never a particularly active bun. She still tries to groom herself (falls over if she uses both hands but can do it by lifting one hand at a time). Still tries to move around occasionally. Eyes sometimes look very alert, other times not so much.

Affection = She’s never wanted anything to do with me so it’s hard to rate this. She still grunts at me and has tried to stomp at me a couple times so I’ll consider that her sign of affection

Oh…one other thing. I try to massage all around her neck and shoulders at least once a day. Would it be helpful or harmful to try to move her head around? I seems like it might be helpful so it doesn’t atrophy in that position. I haven’t done it yet though in case it could be harmful or painful.

 

[Flashy]

That's so sad that she is struggling so much Is she next to her bonded bud? I just wonder if maybe having him around, really close, might help her stay calmer.

With Tilly, when she was undergooing her treatment I did do massages, I did move her head and I did do physio with her.

At that point though, Tilly had lived with her tilt for a fair amount of time, just untreated (she was seized by the RSPCA as a neglect case).

I used to massage her, and also used a heat source on her neck (after I caught her lying on one). It might be worth giving Jessie something like a rice sock around her neck sometimes (just warm, not hot), because heat seems to really help.

I used to massage first, and then gradually massage and upright her head so she was completely straight. She used to love it and we got a lot of tooth purrs. I followed her lead and when she had had enough, that was it (and sometimes we hardly got moving with it, but I, like you, didn't want to hurt her), and she got treats after.

In the later days I did physio. I used her favourite food and moved it around in front of her head. I wouldn't suggest doing this when you need to get all you can into her, but maybe when she stabilises you can start to do that a bit. I also started to challenge her with things like ahy racks up high. In the end Tilly could turn her head right round the other way, when she too had started off in a similar way to poor Jessie.

To be honest, Convenia saved Tilly completely. It gave her a complete new lease of life. She went from a 2-4o'clock tilt, to a 1c'lock at worst, but just recently she has been finally sitting upright.


I'm just wondering if an anti inflammatory might help her at all. Does anyone else have any thoughts on that?

 

[Little Bay Poo]

I don't know most of the medications you've listed, and even the ones that I do recognize I can't offer advice since I lack the knowledge. I wanted to ask a general question about Pen G though...I suppose it's not very important but if someone like Randy comes along maybe he can answer. We got conflicting information from our vet about Pen G from what you've written:

cmh9023 wrote:

.25 cc’s PenG every other day (4 doses so far). Yesterday she added .5 cc’s every 7[sup]th[/sup] day in the event of syphilis infection (1 dose so far)

I asked our vet about using Pen G every other day, because I know other members went by this protocol. She said she had never heard of that procedure before and that we absolutely had to administer it once a day for 7 days straight so that the medication could build up to a therapeutic level. If we missed one day, the medication would have no effect. This issue arose because we were having such trouble administering the shots, that missing a day due to botched injection was frequent. Our vet made us start over if we missed a day, and thought it crucial that we get a full 7 consecutive days worth of shots for it the medication to work.

I'm not writing this to alarm you, as I'm sure your vet knows what they are doing. Rather, I'm now very confused about MY vet and why we were given conflicting information.

I am going to make a separate post addressing some of the questions you have asked. Again this post isn't especially important but I figured I'd throw it out there in case we can get some more useful information about Pen G.

ETA: Just so there isn't any confusion...our prescription was Pen G once a day for 7 days, none for 3 days, once a day for 7 days, none for 3 days, etc.

 

[cmh9023]

Little Bay Poo wrote:

I asked our vet about using Pen G every other day, because I know other members went by this protocol. She said she had never heard of that procedure before and that we absolutely had to administer it once a day for 7 days straight so that the medication could build up to a therapeutic level.

Hmm..I'm not sure about that. Hopefully one of the more knowledgeable members will read this. I had another bunny that had to take PenG injections for about 2-3 months and they were always given every other day. I'm not sure about the rationale behinduppingJessie's dose to .5 cc's every 7th day. But to me stronger sounds better

 

[Little Bay Poo]

cmh9023 wrote:

The biggest issue continues to be the rolling. She can’t move an inch without rolling uncontrollably.

At what point will I know that she won’t be able to stop rolling even with taking meds. If she is going to stop rolling should it have happened by now?

I’ve had an impossible time getting her to take the Meclizine so the pet pharmacist is going to compound and flavor it today. I’m hoping that might help with the rolling?

Meclizine definitely helped Ronnie with his rolling episodes. He needed it 2x a day for weeks and weeks, and if he did not get it we had to bundle him in between rolled up towels just to get him to the vet properly in his carrier.

I know you said that you are having a hard time giving her Meclizine...does this mean that she's missing doses or are you still getting it down her with a bit of a struggle? If she is missing doses, the Meclizine could help a lot with rolling. It is worth a try. BTW ours was compounded, it smelled like nasty cotton candy flavoring and we had no trouble getting Ronnie to take it...hopefully the flavoring will help.

As to when she will stop rolling that is a difficult question. Ronnie had days where he would revert back to more rolling episodes and days where he was really good. The Meclizine did make a huge difference for him though...in combination with the Pen G. It seemed that when he was off one or the other the rolling came back.

One thing I noticed was that he did so much worse in confined spaces. The smaller the space the worse the rolling. His carrier was BAD and we had to bundle him in between towels. Some nights we let him stay outside of his cage because he was too disoriented inside the cage. Ronnie liked open spaces. He was able to run around without rolling for the most part though, which is why we were able to have him out and about.

Maybe you could start Jessie off in a very padded but relatively open area. If this is too much, a padded smaller enclosure should do until she can get more on her feet. I would suggest that if you see she is able to run around a little bit without too much rolling, to let her in gradually more open areas. We found that the exercise and open spaces really helped, as I think they get disoriented with more barriers and obstacles in the way. It always seemed like Ronnie would get caught up on corners, or chair legs, trying to figure out how to navigate around them...and the slower he would go the more prone he was to rolling over.

Since I'm getting long winded and I don't know how to make multiple quotes in a reply, I'm going to go ahead and make another post

 

[cmh9023]

Flashy wrote:

That's so sad that she is struggling so much Is she next to her bonded bud? I just wonder if maybe having him around, really close, might help her stay calmer.

She is right next to her bud with just a NIC wall between them (and her bumpers) and I do let them together in the evening when I'm am nearby and can her any commotion from rolling. Unfortunately the way she has position herself to lean against the side of the litterbox makes her head kind of face the wall and they really haven't been interacting. But, I am just glad she knows he is there

I used to massage her, and also used a heat source on her neck (after I caught her lying on one). It might be worth giving Jessie something like a rice sock around her neck sometimes (just warm, not hot), because heat seems to really help.

Dumb question but I've never heard of a rice sock. Is it something sold at a store or is it simply rice in a sock?:?

I used to massage first, and then gradually massage and upright her head so she was completely straight. She used to love it and we got a lot of tooth purrs. I followed her lead and when she had had enough, that was it (and sometimes we hardly got moving with it, but I, like you, didn't want to hurt her), and she got treats after.

That's good to hear. Unless I hear otherwise from someone else I am going to start moving her neck as seems appropriate. It seemed like a good idea to me.

To be honest, Convenia saved Tilly completely.

I haven't heard of that one. I will look around the forum for past info. Is it an antibiotic?

I'm just wondering if an anti inflammatory might help her at all. Does anyone else have any thoughts on that?

I do have Metacam at home so I'll be watching to see if others have any thoughts on this.

 

[Maureen Las]

There is a difference between penicillins so terminolgy may be the issue here

Pen G procaine is a short acting penicillin. If this is the only penicillin used it would need to be given DAILY.

Benzathine Pencillin is a longer acting pencillin and would need to be given every other day .

The combination of the 2 pencillins is called bicillin and is a combination of procaine penicillin G and Benzathine penicillin and would be given every other day. The advantage of bicillin is it's extra potency

I believe many people refer to bicillin as Pen G when it really is the 2 penicillins

Little Bay Poo ..your vet probably was using procaine G alone which would make it very necessary to give it daily in order to maintain a constant blood level.

 

[Little Bay Poo]

cmh9023 wrote:

The other bad news is that she hasn’t pooped since sometime Saturday. (Just a few tiny ones, no cecals at all).

Appetite = Pretty good. Eats hay and some greens and a little oats. If she doesn’t take initiative to eat, I feed her piece by piece dipped in water and she will eat a fair amount.

Has the vet been monitoring her weight? When Ronnie was sick he dropped some weight and he stopped eating his pellets. Although he was still eating a lot of hay, it wasn't enough to keep his weight stable. We were instructed to give him Critical Care multiple times a day. This can be a stressful experience for some rabbits...Ronnie took to it quite well (he was an excellent patient)...but Critical Care might be something to consider if you are noticing a drop in weight. We got the Apple Banana flavor.

As for the poops, we noticed a change as well. However, I believe Ronnie was producing them daily so I'm not sure what to do in case of no poops. With Ronnie though, I can tell you that all he was pooping out was Critical Care, and with the combination of medications they were much smaller in size and lighter in color than his normal. This lasted for over a month and he didn't get back to producing normal fecals until he was off the medication and back on his normal diet. Our vet was more concerned that he was producing something (even if it was smaller than normal), so no fecals is an issue to be addressed. I don't know the drugs you've mentioned, so maybe Randy or angieluv can shed more light on that.

 

[Little Bay Poo]

angieluv wrote:

There is a difference between penicillins so terminolgy may be the issue here

Pen G procaine is a short acting penicillin. If this is the only penicillin used it would need to be given DAILY.

Benzathine Pencillin is a longer acting pencillin and would need to be given every other day .

The combination of the 2 pencillins is called bicillin and is a combination of procaine penicillin G and Benzathine penicillin and would be given every other day. The advantage of bicillin is it's extra potency

I believe many people refer to bicillin as Pen G when it really is the 2 penicillins

Little Bay Poo ..your vet probably was using procaine G alone which would make it very necessary to give it daily in order to maintain a constant blood level.

Ah, I see. Thanks so much for the clarificaton!

 

[Flashy]

A rice sock is literally uncooked rice, in a sock, heated in a microwave. You can obviously get the warmth from it that you want (i.e. hotter or cooler), but heat definitely made a difference to Tilly and she seeked it out. Maybe it is worth trying something like that for Jessie. Really easy to do, and flexible.

In terms of the neck, I would really just go with her lead and see how she does. Tilly was happiest when I was massaging her and her head was upright, so it was right for her. It may be right for Jessie, or it may not be right for her now if the world is so disorientating, but might become right for her in the future. If you follow her lead and pay attention to her signals, you can't and won't go wrong

Convenia is an anti-biotic. It's not commonly used yet, but Randy put me onto it and my vet agreed. It is normally used in cats and is normally given every 14 days, however we gave it every 7 days for two months to Tilly (that was after we started at 14 days and she got loads better, then relasped, so we cut it to 10 days and she did the same, but when we decreased to 7 days she remained stable).

 

[cmh9023]

Little Bay Poo wrote:

I know you said that you are having a hard time giving her Meclizine...does this mean that she's missing doses or are you still getting it down her with a bit of a struggle? If she is missing doses, the Meclizine could help a lot with rolling. It is worth a try. BTW ours was compounded, it smelled like nasty cotton candy flavoring and we had no trouble getting Ronnie to take it...hopefully the flavoring will help.

She hasn't had any in about 3 days I tried mixing it with everything...applesauce, banana, pumpkin, etc. Finally I mixed it with Pedialite and gave it with a syringe. But I always ended up with most of the blue powder left in the end of the syringe. I am getting cherry flavor because that's what her Oxybendazole is and she seems to be ok with that.

Maybe you could start Jessie off in a very padded but relatively open area. If this is too much, a padded smaller enclosure should do until she can get more on her feet.

I have tried that a bit. She starts to roll fast right away. I freak out and rush to stop her. Then she grunts at me...haha. Hopefully once she gets a few doses of Meclizine she will at least be able to balance herself and just tip over rather than roll I can try more open padded space again. The problem seems to be that she can't stop rolling until she crashes into something and once she crashes she can't right herself back to her feet.

 

[Maureen Las]

Cara

I have never had a head tilt bunny so I cannot help in the way that others who have hands on experience can.

I do believe that fenbendazole is more often used than oxibendazole and may be more effective but since they are in the same family it probably is not a significant difference. Panacur is fenbendazole and actually when Babette was bad we tried it on her as a last ditch attempt to determine what was happening to her. It did not work at all.

Randy has been extremely busy but I have noticed that he stops in the forum particularly on weekends. I am wondering if your vet would talk to him . He has used Marquis but I am unsure as to how he gets it and/or dosage

Panacur or fenbendazole can be purchased at farm and fleet as a goat dewormer in liquid form. it is exactly the same mg/.ml as what the vet gave me.

Another factor that has crossed my mind is whether the head tilt is caused by something other than EC or an ear infection and whether possibly a head x-ray could rule out other factors (this is coming from book knowledge and no experience)


http://www.medirabbit.com/EN/Neurology/head_tilt.htm
There are other rarer reasons for head tilt
I know that since Jessica was a shelter rabbit with other issues that you really have no idea what she was exposed to prior to being in a shelter. I would guess advanced syphllis could have neurological implications but am not experienced with that
I am sorry that she is going through all this. I ,too, would have a lot of trouble watching any one of my rabbits in this condition without any resolution.
'hugs"

Maureen

 

[Maureen Las]

Just forgot also that if your vet would talk to Randy he could bring up all of the advantages of Convenia....

 

[cmh9023]

Little Bay Poo wrote:

Has the vet been monitoring her weight? When Ronnie was sick he dropped some weight and he stopped eating his pellets. We were instructed to give him Critical Care multiple times a day.

Her weight has beenholding steady and her temperature has been normal. She goes in for fluids tomorrow so she will be weighed, etc. again.

I do have Critical Care at home and have thought about giving her some. The problem is that even in the best of circumstances she struggles against a syringe more than any bun I've ever had. With her being so disoriented it seems like it would be even more horribly stressful for her. But...it might be time to bite the bullet and do it.

I am very concerned about the lack of poop. It's almost as if i didn't even notice it was missing for a day or two because there was so much else going on with her. I'm usually VERY aware of the poop situation with all my buns

You guys are all awesome for taking the time to read my long winded posts and for all the advice!!!

 

[tonyshuman]

Yes, it is bicillin that is given every other day.

I think meclizine would help.

I am a bit confused about the medications. Oxybendazole is an antiparasitic, that would be effective only against things like EC. If the vet doesn't think it's an EC infection that's causing her tilt, but a bacterial infection, why are you continuing on the antiparasitic? Marquis is also an antiparasitic, as is fenbendazole.

Convenia is an antibiotic, that I think can be used alone or in conjunction with bicillin. If the EC titer does indicate that she may have been exposed to EC but does not have an active case, I would try the most aggressive antibiotic therapy possible.

For food, I would give Nutri-Cal and Bene-Bac in addition to normal food to stimulate appetite and keep GI flora going, respectively.

As for her quality of life, that's really something we can't determine because we can't see her. I would wait and see if the meclizine helps her feel more comfortable and roll less frequently. Then you might be able to put her back in with her partner.

 

[Little Bay Poo]

If you are getting her to eat moist greens I would try adding Critical Care to that first before using a syringe. If she is maintaining a steady weight then there may be no need for it at all. With Ronnie it was just that he was refusing everything except for hay...we couldn't entice him to eat anything else. So for him, the Critical Care was necessary.

 

[cmh9023]

tonyshuman wrote:

I am a bit confused about the medications. Oxybendazole is an antiparasitic, that would be effective only against things like EC. If the vet doesn't think it's an EC infection that's causing her tilt, but a bacterial infection, why are you continuing on the antiparasitic? Marquis is also an antiparasitic, as is fenbendazole.

My vetDID think it is EC and then the titer came back positive to confirm it. It's me who is being pushy about there being aninfection. From reading past posts my understanding was that vets will say "It's EC" but that it can't really be "just EC". That there must be some sort of deep infection or other issue that accompanies it. Am I understanding correctly? This is all so confusing. So I was the one to push to add PenG to the Oxybendazole so itmight "cover" both things. What do you think would be the most aggressive antibiotic therapy? She is open to Chloramphenical if I want to try it.

For food, I would give Nutri-Cal and Bene-Bac in addition to normal food to stimulate appetite and keep GI flora going, respectively.

I haven't found a way that she will take the Nutri-Cal. My other buns have all loved it and licked it right up when they had to take it. Maybe I'll just have to wipe some of it right into her mouth. I have Bene-Bac but I can't remember how to serve it. One problem is she won't eat ANY kind of treat food to mix these things with.

 

[Maureen Las]

I understand the confuson and to be honest I would have done the same as you are in terms of pushing for the antibiotics. You have read all those threads correctly ; most of us feel that there is an underlying infection
even in the medirabbit article it states that head tilt is usually not the first symptom of EC

if you have the gel form of benebac try to find the powder form . it is easier to get in them as you can mix it with juice if you want to .

 

[emilyasb]

Ah, poor lad =[
I hope he comes through this with flying colors!
-warm bunny wishes coming your way =]

 

[ra7751]

Hi,

If your vet is confident this isn't an infection in the ears....I would find a rabbit savvy vet. Your vet is obviously reading inaccurate information regarding EC from old and outdated reference materials....sounds likeThe Merck Manual (and this book is scary) or The Five Minute Vet Consult. EC does not cause head tilt. It does compromise the immune system since the EC is considered the highest threat. Active EC rabbits will have roving infections. EC usually also presents as some type of neurological deficiency in the hind quarter (always in the left rear leg with the numerous cases I have worked here) along with some degree of urinary incontenance due to the EC spores shedding and passing thru the kidneys. In the absence of head trauma, the only thing I have every seen cause tilt has been a problem in the ears. If an ear infection isn't properly treated, it will escalate and mestatasize to the brain or brain stem. The "bendazoles" have been the most recent treatment for suspected EC invasions. Truth is, these drugs have a nearly impossible task of penetrating the blood/brain barrier. A much better choice would be Marquis (Ponazuril). Used to treat Eqine Protozoal Myeloencephalitis in horses....very closely related to EC. And it can pass the blood/brain barrier. This drug is extremely expensive. But I seriously doubt that EC is the primary issue here.

I dose Penicillin sometimes every day and at very high dosing....very high. That is the only way to get the working levels up....the only thing youdo with the once a week thing is to make the bacteria resistant...infection control 101...basic stuff. The only side effects I have ever seen from Penicillin is a minor skin issue at the point of injection. I use a very specific verson of Penicillin known as Pen G..it contains two drugs..Procaine and Benzathine and each work in a little different way and with a littledifference in timing. It is essential to perform a culture to see what is...and what isn't...in those ears. If I have presentations of a bacterial infection and get a clean culture...I treat for Pasteurella. I have also seen Staph and Pseudomonas as well as yeast in vestibular issues. With most bacterial infections, I use a cocktail of Penicillin and Zithromax. And depending on the results of the culture....I have also use Convenia, Chloramphenicol and Zeniquin. I do not use Sulfanomides or Baytril.

Meclizine helps some rabbits but not all of them respond to this drug. But valium can be a very good thing.

Few vets know how to properly treat a vestibular infection in a rabbit....they are far too conservative. I do not play with ear infections....I fire the big guns. Not intending on flaming your vet....but this line of treatment your rabbit is currently onsounds a bit out of date.

Randy