Unresolved head tilt and constant rolling

[cmh9023]

I'm SOOO excited to have a reply from Randy!!! I was hoping, but I know you have very limited time to spend on the forum. Thank you!

ra7751 wrote:

Hi,

If your vet is confident this isn't an infection in the ears....I would find a rabbit savvy vet.

I've read as much as I can from old threads about EC, infections, etc. and I could tell from the beginning that what sheis prescribing seems very old school. The scary thing is that she IS one of the main rabbit vets in our area. I just haven't trusted this whole regimen from the beginning. By nature I'm not at ALL an assertive person and I've been trying to give my suggestions without offending her. I think I am going to make Jessie an appt with the vet that Treasured Friend goes to. Maybe starting from scratch with someone new would be best.

Your vet is obviously reading inaccurate information regarding EC from old and outdated reference materials....sounds likeThe Merck Manual (and this book is scary) or The Five Minute Vet Consult.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 wonder if my vet would even have heard of Marquis? When you say expensive what is the approximate cost? Do you know if anyone else on the forum has tried it? I'm up for trying anything.

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.

She has been taking PenG: .25 cc’s every other day (4 doses so far). Yesterday the vet added .5 cc’s every 7[suP]th[/suP] day in the event of syphilis infection (1 dose so far, explained above). Does this sound like a high enough dose? And a big enough gun?

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.

I absolutely do not understand why she hasn't done a culture. Through the tech she told me that there is no good place to take a swab. What?! And the blood work she sent in was only for EC. Usually she does an IDEXX Health Check Plus which I think is a full blood panel. Her titer was .615.

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

Wow..I don't think I've come across that anywhere so far. Again, is this a unique treatment or is it something she may have used in rabbits already? Jessie took her first dose of liquid Meclizine at 5:30pm. No change so far. I've set my alarm for 1:30am to give the second dose.

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

 

[ra7751]

Thank you....but I think you have already received some excellent advice and I think you know a lot already. As far as being assertive with the vet....not saying to be ugly or anything....but you are paying the bill so you are the boss (within legal limits of treatment anyway) plus ear infections are nothing to play with. The real responsibility of treatment lies with you...not the vet.

The EC titer is just checking antibodies....and nearly everything will titer positive for EC. The titer is not a diagnosis....EC can only be definitely diagnosed during a necropsy. It is part of the puzzle. Ever watch the TV show House? Differentials.....that is what we are talking about here....what can and what can't cause these symptoms. I don't bother with the titer for a couple of reasons. One, there are only a few labs in the US that can run this titer and it has to be specially requested as part of a CBC. And it is just such a small part of the puzzle....I make my decision on EC based on overall physical presentations.

What kills me though is that I understood about the titer results, EC not beingetc. just from reading this forum. It seems like a vet would want to keep up with the times. It's just frustrating

Just wondering....did your vet check the body temp? I have seen fevers in ear infections range up toward 106*F....that is brain cooking temps.

Her temperature has been normal throughout this and her weight is holding steady. She's eating surprisingly well. She's getting fluids tomorrow so she'll get her temp, weight, etc. taken again then.

Valium is something we are using a lot. Use it mostly for head or spinal injuries. The "Blast from the past" treatment was always to not sedate and administer steroids. The new way of doing things is to sedate and not to adminster steroids. Valium is the main drug used to sedate...it slows the brain down and will reduce the spins. Meclizine is much like an anti-histamine....and it doesn't work in all rabbits. The valium is something that emergency vets are quite familiar with. And I think they are using ACE in dogs and cats....and I have heard of it being used in rabbits.

How many doses of Meclizine should I try before assuming that it is not going to work for her?

Something I didn't see you mention....does your rabbit have nystagmus (darting eyes)? The tick might be very slight but that will tell us something. Brain stem infections result in a condition known as positional nystagmus. I have a lionhead with a brain stem infection that does pretty well in her house but will violently flat spin in unfamiliar situations. They type of nystagmus can help determine where the infection is located.

Her eyes were darting the first day or so. Not too much but somewhat. Since then her eyes have not been darting at all.

But I would highly suggest you encourage your vet to perform acytology at the very least on any debris found in the "down" ear. We have been able to see some skull issues with radiographs but it takes a skilled vet that knows what they are looking at to read these rads.

I think you are most likely going to have to find a vet with more rabbit experience. No flaming intended to your current vet. I know first hand what they are up against. They just don't get much exotic and/or avian exposure in vet school. But based on my experience with ear infections and tilt....the game needs to be elevated quickly to a high level to prevent a non-correctable situation. I will be glad to consult with your vet if she is willing.

I had to take one of my buns to the UW Vet clinic in Madison for radiation and had an excellent experience with all the doctors he saw there. I'm going to check but I think you have to be referred by a vet to be a patient there. I would love to go there again. Do you know how their vet school is rated?

Still no poop since Sunday...just some really, really tiny ones. I'm concerned because she is on the third day of Reglan ane Ciscipride and I KNOW that is VERY unpopular on the forum. However I don't know what else to do. I've been talking her in about every third day for fluids and getting as much fluid to her as possible at home on the days in between. There have been times when they prescribed it to me for other buns and I never used it but this is the longest I've ever had a bun not poop for this long.

Randy

 

[ra7751]

Oh...forgot the Marquis. This drug is known as Ponazuril and marketed under the Marquis name by Bayer. It comes in a large syringe with a very large price....in some cases nearly $800 per syringe. But one syringe can treat a lot of rabbits. EPM in horses is closely related to EC in rabbits. This drug is very effective against EPM so it should, on paper anyway, be effective against EC. It's difficult to dose....and there are many different dosing protocols. It's difficult to properly dispense this drug since it's a paste. A paste can have "hot spots" in which there are small pockets of very concentrated drug. In dosing a horse....hot spots don't matter since they are getting an eintire syringe at a time....but when dosing for a rabbit....it gets a little more complicated. The paste has to be weighed and several issues must be resoved before coming up with a final amount of drug....but it shows great potential in highly suspected EC cases.

Randy

 

[TreasuredFriend]

Sending caring thoughts and support to you, Cara, as you pro-actively do all you can for Jessie girl.

 

[cmh9023]

OMG...That is such a cute picture of Karla! I'm going to make an appt with Dr. Bloss if my appt on Monday doesn't go well.

 

[TreasuredFriend]

Karla sends you kisses, Cara. I'm at BF early next week, have an appt. w/ Dr. Bloss. Plus if there's anything I can let her know about in case you do seek a 2nd opinion, I shall mention your head-tilt in Jessie.

You are one of the most caring rabbit moms who go above and beyond in the care of your Kids.
Rock star Sherry and your RIP bunners admire you, are grateful.

 

[cmh9023]

Hi everyone who's been helping me with Jessie's head tilt situation,

She got fluids from the tech this afternoon. She is down in weight by about 8 oz but she started eating pellets again this morning so hopefully that will help. I'm giving her a mix of alfalfa and timothy hay pellets (15/23 and Bunny Basics T).

Since we got home she's been rather lively. She's not rolling any less and her head is still the same amount of tilt, but she is trying to move around a lot more. Outside of her padded area was impossible. She would just kind of hurl herself in the direction she wanted to go over and over. I decided she might hurt herself so I put her in the padded area. She seems to be a little more steady on her feet in there today.It's hard but I decided I should probably let her roll a little and let her work on getting to where she wants to go rather than immediately stopping her. I guess that is the only way she will get practice moving around and the only way she can get better at it.

Randy gave me some suggestions about medication for my vet appt on Monday. Since Marquis is pretty much out of the question she'll stay on Oxybenzole. I will ask the vet to add Zithromax to the PenG. That shouldn't be a problemwith the vetbecause I know she uses Zithromax. However I don't know if she'll know how to do the dosing when they are used together. Today was supposed to be her day off of PenG, but I gave her some anyway. Randy said he sometimes gives it daily. I decided to throw caution to the wind . Randy if you read this and that was the wrong thing to do, let me know (or if anyone else knows). Still using the Meclizine.

Thanks all of you for your ongoing help and concern for Jessie!

Cara

 

[Maureen Las]

Cara

zithromax is also called azithromycin
the dosing is in medi-rabbit

http://www.medirabbit.com/Safe_medication/Antibiotics/Safe_antibiotics.htm
I have given it before but the vet here would not give me the proper dosage (which drove me crazy)
I have never used zithromax (azithromycin) with Pen G but that is a combo often suggested by Randy. Maybe someone else on the forum who has used them together can offer suggestions on the dosing (and /or pm Randy )


I do not know if the dosing of the 2 combined is less than individually. That is something that we need to find out. it probably is the same but I am not sure.

 

[Maureen Las]

What happened at the vet's? :expressionless

How is Jessica?

 

[cmh9023]

Thanks for asking about Jessie! Well, we went to the vet yesterday and it went OK. Not great, but I ended up leaving with the medication I wanted so that’s all that matters for now.

I went armed with all the advice I had received from you, Randy, etc. as well as a highlighted copy of the article you sent. My objective was to get a prescription for Zithromax and I got it. I wanted to give the vet a chance to give some suggestions before I butted in, however, the first thing she suggested trying was STEROIDS :X! Needless to say I decided it was time to give MY suggestions.

I think she’s doing it just to humor me, but I don’t care as long is it gets me what Jessie needs. She clearly doesn’t think her problems have anything to do with an inner ear infection/inflammation. It’s simply, “I think it’s EC”. OK, whatever. So now Jess will get PenG, Zithromax and Oxybendazole. I think I’m also going to learn to give fluids because she really seems to perk up after getting them.

She’s doing pretty well. She still can’t move around without rolling and her head is still at 3:00, but it seems like she’s regaining a little of her strength and is more steady on her feet when she’s standing still. She’s leaning less on the bumpers, I think. And she's interacting a little more with Button.Her appetite is still good although I wish she’d eat more pellets. She never did eat much even when she was well. She just loves her hay and veggies. I just want to make sure she keeps her weight up.

All the help from this Infirmary sectionhas beenawesome and thank you for all of your time everyone! Maureen- You should put that article in the Library section. To me, it was one of the most thorough and easy to understand articles about head tilt I’ve read.


Cara and Jessie

 

[Little Bay Poo]

I'm glad you were able to get the medications you wanted. Hopefully the Zithromax and Pen G combo will do the trick. It sounds like Jessie is doing well...sometimes it takes a long time to see improvement. If I remember correctly, there was a good bit of time where Ronnie was "stable" and then suddenly out of nowhere we noticed an improvement in the degree of tilt. At one point he was also tilting to about 2 or 3 o'clock.

You mentioned wanting to make sure that Jessie keeps her weight up. Do you have a scale at home to weigh her? At first we were relying on vet visits to monitor Ronnie's weight, but as he kept slowly dropping, we decided to weigh him at home to better monitor the amount of Critical Care to feed him. We bought an expensive letter scale from Office Depot a long time ago and used that, but I know some people have mentioned buying cheap scales at Walmart.

 

[cmh9023]

Getting a scale is a really good idea!! I don't know why but I never even thought of that. It would be good now for Jessie but also just to have on hand if another bun gets sick or seems to be getting chubby. I'm definitely going to get one.

Did you know Jessie's partner is a tiny little Nethie guy like Ronnie and Billy? He's gray (blue officially, I guess) and tops the scales at an even 2 lbs. It's funny how much bigger she is then him when they are next to each other. He's in the avatar but you can't really see either of them very well.

Cara

 

[Little Bay Poo]

cmh9023 wrote:

Did you know Jessie's partner is a tiny little Nethie guy like Ronnie and Billy? He's gray (blue officially, I guess) and tops the scales at an even 2 lbs. It's funny how much bigger she is then him when they are next to each other. He's in the avatar but you can't really see either of them very well.

Aww...from what I can tell he looks really cute! After seeing a blue Nethie at the pet store last year, it's my new favorite color :biggrin2:

At his low, Ronnie was getting close to the 2 pound mark, but he's slowly been chubbying himself up on oatmeal and pellets. I'm afraid to weigh him now because he feels really fat!

 

[Maureen Las]

I think that you did great Cara!!

It is hard for me to disagree with vets also I just hate to do it BUT when it is necessary I will do it for the bunny.
I'm so glad that you got what you wanted..
steroids would just reduce the ability of the immune system to fight !

I'll put that head tilt article in the library

Now I'm going to be interested if any of this helps Jessica.

You 're a great mom to your buns Cara.
we'll keep our fingers and paws crossed here

 

[tonyshuman]

Yay for standing your ground. I think the Pen G/zithromax combo would be a good antibiotic attack on this infection. I'm glad the vet gave you what you wanted (and NOT steroids) and you can still put her on the antiparasitic to make the vet happy.

I have gotten a kitchen scale at wal-mart for ~$7. It works well and weighs by ounce, which is helpful.

So now it's time for her to start getting better!

 

[naturestee]

That's great news! I'm glad she's interacting with Button a bit more too. It must have been hard on her, what with feeling that bad. He must have been a lonely little guy too. They are so cute together!

Edit: If she's not keeping her weight up, you could try adding a little sunflower and flax seeds, oats, and a little alfalfa hay. I used to give her sunflower seeds and oats to keep her weight up when she had her babies. Those treat foods are probably more interesting than pellets anyway!

 

[tonyshuman]

Oh, I forgot this is the bunny formerly known as Jazzy! Such a strong girl--I bet she'll get through this!

 

[cmh9023]

Thanks, everyone!

Yup, Jessie aka Jazzy! I keep saying to her, "If you can make it through having 10 babies as a teenage mother, this will be a piece of cake!"

She has hospital visiting hours with Button from about 6pm-10pm. I can't leave them together all the time yet because she still tips over very easily AND he eats all the food...haha...He did the same thing when Sherry was sick and became a little round tub (it was alfalfa pellets)!

Jessieis SOOO picky about eating. The ONLY "treat" kind of food she will eat is a little bit of oats. No pumpkin, no banana (whole or mashed), no apple (whole or applesauce), no baby food, no Nutrical, no nothin'. Since she has been sick I've been giving her a combo of pellets- 15/23 and Bunny Basics T. I'll pick up some alfalfa hay and sunflower seeds tomorrow and I have flaxseed at home. I'll give that a try tonight.

As far as the medication, I was fortunate enough to have some PM's from Randy and he suggested combining the Zithromax. He also gave me some tips on adjusting the dose of her PenG. I decided to not even try to discuss the Marquis with my vet. Since even he says its hard to get, I'm sure they wouldn't know anything about it. Plus when he told me the price that sealed the deal...yikes!

Do any of you give fluids yourself?

Cara

 

[Maureen Las]

Here is a whole page of you tube videos on sub q's

the first one for a cat is good but if you just watch them all it may help

it isn't hard at all once you get used to the equipment and particularly to the tenting of the skin to place the needle. it is the same as giving the pen G
I did not know that you adopted Jazzy ;I didn't know that was Jessica LOL


http://www.youtube.com/results?search_type=&search_query=giiving+subqutaneous+fluids+to+a+rabbit&aq=f

 

[Maureen Las]

How is Jessica doing ?

Any changes?