Hi,
I have a huge concern here. Just how was E Cuniculi diagnosed? The fact is...E Cuniculi does not cause head tilt. This is a very common misconception even among vets. And truthfully, very few vets have ever seen an actual EC infection. I have treated many rabbits that were EC positive and many that tilted. In every case except two, the root cause of the tilt was an infection in the ear. While EC doesn't directly cause the tilt, it does overwhelm the immune system to the point that opportunistic bacteriainvade. The ears are the weakest link in the body of a rabbit..and usually the first to suffer theinduced secondary infections from the EC. EC rabbits can have "roving" infections...this month it is the ears, next month urinary tract, next maybe the eyes, etc. The two cases of tilt that were not ear infections were cottontails with obvious head trauma. We have had EC rabbits that never tilted but presented all other neurological deficiencies....and we have had non-EC buns tilt from stand aloneinfections.
I think Sparky is in our blog. He tilted while at a pet store. He was diagnosed with EC and treated for that. He had a major ear infection. Had it been treated properly to begin with, he would not have to spend the rest of his life twisted around.
As far as diagnosing EC, the only true method of pinpointing EC is a post mortem exam of brain tissue....that is not a desired result. There is a blood titer that checks for antibodies in the blood. To get anything near an accurate look, it requires several titers to be performed over a period of several weeks. The idea of the test is to see if the antibody levels are rising or falling. If they are rising, the thinking is the infection is active. If the levels are falling, the event in maturing. This test leaves a lot to be desired but is the best we have now.
I have had the distinct displeasure of treating numerous EC positive rabbits here....in fact, our rescue is named in honor of Sabrina. She was my very first rescue....and daddy's little girl. I lost her to EC....and nobody had ever heard of this issue back then. She is my reason for learning and researching so much about this issue. In every case of active EC, the first presentation is neurological....in every case here, the left rear leg showed issues. In the beginning, it appeared to be a "lazy" leg....a little stumble here and there. It got better but came back. There is also a change in the urine as the spores from the protozoa shed. This causes scar tissue and pitting inside the kidneys which reduces their efficiency. This results in a very smelly and concentrated urine. Many times the rabbit will stay wet with urine. It is most often misdiagnosed as a bacterialUTI.
Treatment for EC is challenging. The latest and greatest is the "bendazoles" and Fenbendazole (Panacur) is the latest in that family. I have not seen it to be particularly effective.It has a tough time penetrating theblood/brain barrier.I don't use is as a "stand alone" but as part of an overall attack strategy. In reality, to get EC into remission....it will be the rabbit's own immune system. Supporting the immune system is paramount in an EC event. The drug with the most promise for an effective treatment is Ponazuril and is marketed by Bayer as Marquis. It is designed to treat Equine Protozoal Myeloencephalitis (EPM) in horses. It appears, on paper anyway, that the organisms that cause EC in rabbits and EPM in horses are very closely related. A bright spot for a horrible condition. I have not had the opportunity to use my theory but I bet some real doctors have figured this out already (I had a rabbit ready for treatment but lost her to kidney failure from EC before we could treat her).
I am not a vet...but here are my suggestions based on my very long term experiences with "special needs" rabbits. I would get back in to see the vet as quickly as possible. I would look very carefully for "markers"....using x-rays and/or cultures if necessary. I would take a long and hard look at the ears....and since she is tilted right, the issue is on the right side. Just because an infection can't be seen by the naked eye (or by an otoscope) does not mean there is not an infection. And don'tdiscount the possibility of a dental issue with the roots of the upper arcade molars....and that can onlybeseen by radiographs. A blood panel will also help piece the puzzle together. Check the rectal temperature. Look at her eyes. Do they move when they shouldn't be....maybe a very slight tick. You might have to look closely. If they tick, that is called nystagmus and would be an indication of a vestibular infection (or head trauma). If the eyes tick only when she is picked up, that is called positional nystagmus and usually is caused by infection that has moved into the brain stem. Ear infections require a major treatment protocol. I would also request that the vet access the internet and consult with other doctors on protocols and clinical diagnosis for EC.
Again, I am not a vet and it is not my intent to "flame" the doctor. I have the utmost respect for vets....they are all fantastic people. But I am hoping to give you some ideas to pursue based on my many years of experience. I have no problem with using the Panacur protocol since it will at least deworm her...but I would really go the extra mile with those ears.
Randy
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