Feeding Head Tilt Bunny

[Sabine]

My almost 5 year old Netherland Dwarf girl Asha has suddenly come down with severe head tilt two days ago. She has been getting regular injections since but the tilt really hasn't improved.
I am really worried about her ability to eat and drink so I have started syringe feeding her food an liquids. I am finding this very difficult as I am virtually feeding her upside down. Whenever she spits some out it end up in her nose. The way she curls up I can't find a better way of feeding her.
She seems to be eating tiny amounts of food herself and I found a small bit of poop in the cage this morning. I wonder how much and how often I should feed her. She only weighs 900g. I somehow can't judge how much she should be getting.
Any advice would be of great help!

 

[JBun]

Did the vet give you Oxbow critical care food mix to syringe feed her with? That's usually the easiest and best thing to be feeding a sick rabbit. If you don't have it, you can ask your vet about it. Are you syringing the food and water into the front or side of her mouth? When I syringe fed one of my rabbits that is 1.3 kg, I fed about 6-9cc of food mix, every 3-4 hours. If you water yours down much, then you would need to feed more. If you are just feeding mashed up pellets, then you would just take the amount that you normally feed in a day, and divide that up into 5 or 6 feedings. You could try giving your rabbit a neck massage before syringe feedings, as it may help loosen up the muscles a bit, so that the head tilt isn't as severe.

What medication is the vet injecting for the head tilt? Usually they will treat for an ear infection with antibiotics, but head tilt can often be caused by a protazoa called e. cuniculi, so it's a good idea to treat for the EC at the same tine. The treatment is with fenbendazole(Panacur) at 20mg/kg once a day for 4 weeks. This treatment needs to be started immediately, especially with how severe the head tilt sounds, and your buns lack of response to the injections it's getting. But talk to your vet right away, and get your bun started on this other med. Here's some info on e. cuniculi.

http://www.bio.miami.edu/hare/tilt.html

 

[Sabine]

I am syringe feeding a critical care equivalent called "Recovery" which is easier to avail of in Europe. I syringe into the side of the mouth. She is being treated with baytril and another antibiotic. I forgot to ask about panacur. The last time I dosed all my rabbits with it is almost a year ago and i am kicking myself now that I let it slide. It is also not helping having wild buns visiting on a regular basis at the moment...

 

[tonyshuman]

The head tilt is most likely to be caused by an ear infection, so I wouldn't worry about panacur at the moment. If you think it could be EC-related tilt, check for vertical vs. horizontal nystagmus as shown on this webpage: http://www.medirabbit.com/EN/Neurology/Otit/otitis.htm

You might want to get her on some sea-sickness meds--meclizine is used frequently. She may also need pain meds. Often the vets treat the infection but forget about trying to get the bunny feeling better in the meantime while the antibiotics start working--the seasickness meds and/or pain meds can help her to feel more willing to eat. Can you get her to eat the stuff out of a plate? How much of a tilt are we talking? More than 90 degrees? A bunny burrito may be your best option for her:
http://www.medirabbit.com/EN/Transport/Towel/Towel.htm

Are your buns up to date with vaccines? I would worry about that with wild buns in the area.

 

[Sabine]

Thank you for the replies. Yes my rabbits are up to date with vaccines. I knew there were wild rabbits in the area bit it is only been in the last few months that we have been having regular visits to the garden.
That link was very interesting. Strange you say about the sea sickness as when I was watching her eyes I thought of sea sickness myself and even felt a bit nauseaous but thought it was my human interpretation of her condition. I can't really tell what way her eyes are moving as they are relatively still at the moment. I would think they tend to go more side to side (horizontal?). What would that indicate?
The tilt is very dramatic. At times she is totally on the side rolling over and over or it is almost 180 degrees.

 

[tonyshuman]

Horizontal is more indicative of an ear infection. I would look into the meclizine for sure. They sell it sometimes over-the-counter for people and this mentions dosing
http://en.allexperts.com/q/Rabbits-703/Dosage-Meclizine-Wryneck.htm
Poor girl. I can imagine it being very difficult to get her to eat. I wonder if she would lick it off of something instead of having it put in her mouth? If she's feeling really unwell she probably won't want to do that. You might try canned pumpkin or one of the baby foods instead since they're more tasty than the Recovery stuff.

 

[Sabine]

I checked her this morning and she had eaten all of her pellets and not a scrap of veg left either. I refilled her bowl and she started tucking in straight away. The head tilt is still quite bad but I think the medication must be kicking in. The eyes look much calmer to. We are off to the vets this morning for another shot. Hopefully there'll be improvement over the weekend.
Thank you for all the help and info!

 

[Sabine]

We are going to be back for one more injection tomorrow. Thankfully her appetite has greatly improved but the tilt is still severe. I asked about travel sickness remedies but my vet was a bit vague about it and only familiar with those for cats and dogs. I might have a look at the pharmacy later.
Unfortunately my vet will have to order in Lapazole (licensed panacur for rabbits) so I won't get it before Monday. I hope the weekend brings some improvement. The poor thing she has never been sick nor on her own in a cage for the last 5 years.

 

[JBun]

I don't know if you will have this available there, but here we have a goat dewormer called Safeguard, that is fenbendazole, the same antiparasitic as Panacur, and it can often be found at animal feed stores. So if you are concerned about your rabbit having it sooner than Mon., you could try calling a feed store to see if they have any.

You may also want to ask your vet about picking up some Metacam suspension, which is an anti inflammatory. Not only will it bring down inflammation(if there is any), but will also help control any pain, which can affect a rabbits eating.

 

[pamnock]

Nutri Cal for cats/dogs is an excellent way to provide nutrition/energy without having to syringe large amounts of messy mix.

 

[Sabine]

Thank you Pam, I will have a look if I can get hold of nutri cal and keep in in the medicine cabinet. Thankfully Asha is eating well by herself now so I have stopped syringing at the moment.
JBun: I used a sheep wormer called Parazole in the past. It was always a nightmare to administer as the buns didn't like the taste. If the Lapazole doesn't arrive soon I will have to go out though and use it again.
Thank you very much for everyone's replys. I found some of the links really useful and will be forwarding them to my vet.

 

[Sabine]

Asha has deteriorated since I posted this morning and I am back to syringe feeding her. She has moments when she perks up and shuffles around in the cage seeking out the food and water but apart from nibbling on a few dried herbs and hay she hasn't touched much. her poops are also getting less and smaller. She seemed very apathetic when I fed her earlier. I rooted out the Metacam but realized it is several months out of date so maybe not the safest option.
I also noticed that she makes rattly sounds when breathing. She actually did that from the start but I mistook it for grumbling. I only now realize that it is her breath making that sound. I wonder is that part of the condition or could anything else be going on?

 

[tonyshuman]

Oh no, I'm sorry she's not doing well. I am not sure about the breathing, but it could be something like a snore where the soft palate is moving against the throat, since her head is in an unusual position. It could also be something much worse, like chest congestion. I think she needs in-patient hospital care if you can do it. It would be good to get her in a nice, warm incubator with a higher oxygen content in the air if possible, and maybe she'd tolerate an intra-nasal feeding tube to get the food into her.

 

[JBun]

I'm so sorry she's not doing better. Were you able to start the fenbendazole? It couldn't hurt to try it since she's not getting better, and it may actually help. The metacam would help as well. I'm sure a few months past expiration shouldn't matter too much if it's all you have right now. If you're into the vet soon, you may want to pick up a new bottle. I hope she shows some improvement soon.

 

[Sabine]

We went to the vets yesterday and will be injecting the baytril ourselves for the next few days (till Thursday). She also got a shot of Metacam and long acting penicillin. I started her of Lapizole (fenbendazole) too but her condition has not improved one bit. The head is totally tilted and she topples over a lot and ends up lying down with her legs up in the air.
I am still syringe feeding and also got hold of some Critical Care. She is actually eating a small bit herself and there is a good bit of poop and pee in her cage. It worries me that she is not seeking out the litter tray anymore but pees on the blanket and stays lying in it. I change them regularly and have thick towels underneath too.
I am actually beginning to wonder for how long treatment is useful or am I just prolonging her torment. It has been 7 days now with full treatment and her condition is no better than at the start. She can't be on baytril for that much longer.

 

[Sabine]

P.S. The rattly breathing noise has stopped. Maybe it was just her awkward position and she has adjusted somehow.

 

[JBun]

If the head tilt is being caused by the e. cuniculi protozoa, it may take several days on the fenbendazole to see any signs of improvement, and even when the full 4 week treatment is given, there may still be some permenant damage done, but it should halt the progression, if it's not too severe yet, and improve her condition.

 

[tonyshuman]

I think the head tilt in this case, like most cases, is due to a bacterial infection, especially since you observed horizontal nystagmus. EC-induced head tilt is a later stage of the disease and usually the bunny looks very sick before they start to get a tilt. They would have had hind leg problems and urinary problems for several weeks before a head tilt would set in. The nystagmus in EC is also vertical instead of horizontal.

I am wondering if the antibiotics used are not effective. It may be time to switch to chloramphenicol or azithromycin. Chloramphenicol would be my first choice. Also, how frequently is she getting penicillin? It may not be enough. Usually the long-acting/short-acting combination penicillin (procaine+benzathine) is given every other day. Is there also any chance of getting meclizine or another anti-emetic (seasickness med)? The metacam is good, and it's good that she is eating, drinking, and eliminating normally, so she doesn't need the seasickness med to make her feel well enough to eat, but it might help reduce the rolling episodes.

I would also try to set her up in a cage with permeable bedding (like microfleece) on the bottom, with puppy pads or towels underneath. This would wick away urine better. You can also put rolled up towels on the sides of the cage so that she doesn't roll into the walls, and they may give her something to lie on comfortably. I think JadeIcing did something like that with a few of her head-tilt bunnies.

 

[Sabine]

Unfortunately I won't be able to give her meclizine as it isn't licensed in Ireland. I could possibly order it in but it would take a while. My vet has some similar drugs for dogs but feels uncomfortable to prescribe them for a rabbit as dosing them would be very difficult.
I am not sure if chloramphenicol or azithromycin are available for rabbits but I will mention this to my vet when I see her tomorrow.
I put a lot of absorbent towels in the cage and a polyester fleece blanket on top. At the moment she is lying in the (cleaned out) litter tray and hasn't really moved since last night. She is apathetic most of the time but does nibble small amount of fresh food occasionally. I am still syringing critical care and liquids which is a struggle. Her weight has also dropped further and I fear the outlook is not great.
She is getting the fenbendazole and we are injecting baytril. Unfortunately I won't be able to go the vets today and I am not sure if she will make it till tomorrow. She just looks as if she just wants to quietly slip away. I feel gutted to be loosing her as she is my very first Netherland dwarf and she has been such a lovely pet.

 

[tonyshuman]

OK, poor girl and poor you. It's a sad situation and it doesn't sound like things are getting much better. I hope she starts to improve soon. I have heard of giving other seasickness meds to rabbits but I also don't know the conversion. There are formulas that convert these things, but there could be serious issues because some meds do unexpected things in different animals.