Recurring Head Tilt

[butte]

hi just to preface this i am a little bit stressed so this may come out rushed. i will try to include relevant info.

so i have a senior rabbit(9yo), a neutered male netherland dwarf. additional info- we moved at the beginning of the summer. our current house has cats. he may have taken a drink from their water bowl but he doesn't go into the room with their litterboxes. due to his arthritis, he's been peeing outside of the litterbox so we have puppy pads lining his pen that we change periodically. his ears have gotten a bit dry/flaky, so he might have ear mites, but every time i've checked with a vet about it they say he doesn't.

a few years ago he had a bad case of head tilt and came back from it after round the clock force feeding and 2 weeks of antibiotics + subcutaneous fluids administered by the vet.

a few months ago, he got it again, although he didn't lose his appetite as badly this time and it perked up about halfway through the 2 weeks of antibiotics. i was thrilled about his recovery because it was so bad last time we weren't sure he would make it.

tonight as i was petting him i noticed the symptoms had appeared again- the eyes rolling to the side, head listing to his right. it seems worse than the last time, but better than the first time. he is already on painkillers for his arthritis, so i gave him a dose of that since it was time for that anyway, and he seemed as enthusiastic about the sweet flavor as usual. i also gave him a bunch of cilantro to snack on, which he ate no problem and hopped around for a bit. since it is the wee hours of the morning i am still waiting to call the vet but in the meantime trying to gauge how bad this is.

is it normal for head tilt to recur so often? could something in his environment contribute to this? he usually seems so energetic and healthy, and i check his fur to make sure it's clean every day. if there is something i am doing wrong i would like to fix this.

 

[JBun]

Did the vet determine then, that the head tilt was caused by an ear infection and so was prescribed antibiotics each time? Or did the vet say the cause of the head tilt(e. cuniculi, inner ear infection, mites, toxoplasmosis, etc)?

It can be normal for it to reoccur if it's from e. cuniculi especially, as there's not necessarily a cure, but just bringing the chronic illness under control as much as is possible with the appropriate medications. Then it varies as to how successful it is, how long the rabbit can go before needing retreatment, or if retreatment is even needed again.

If the head tilt is from an inner ear infection, this can reoccur after treatment, but usually because the bacteria wasn't sensitive to the antibiotic used, the vet didn't prescribe a long enough course of antibiotics(usually 4-6 weeks is needed minimum), or the antibiotic used isn't penetrating enough to get to the infection.

Reoccurrence could also occur because the cause of the head tilt wasn't properly diagnosed. Like if it started out as ear mites and the ear mites then caused a secondary bacterial infection. And if a vet only treated for an ear infection but missed the ear mites, there could be residual head tilt, or vice versa. Though usually with ear mites, it alone won't be a cause for severe head tilt, but just minor head tilt.

Or in the case of toxoplasmosis, reinfection occurring from continued exposure from living around cats.

https://wabbitwiki.com/wiki/Head_tilt
https://wabbitwiki.com/wiki/Encephalitozoon_cuniculi
Medirabbit: ear infection clinical signs and treatment

 

[butte]

Did the vet determine then, that the head tilt was caused by an ear infection and so was prescribed antibiotics each time? Or did the vet say the cause of the head tilt(e. cuniculi, inner ear infection, mites, toxoplasmosis, etc)?

It can be normal for it to reoccur if it's from e. cuniculi especially, as there's not necessarily a cure, but just bringing the chronic illness under control as much as is possible with the appropriate medications. Then it varies as to how successful it is, how long the rabbit can go before needing retreatment, or if retreatment is even needed again.

If the head tilt is from an inner ear infection, this can reoccur after treatment, but usually because the bacteria wasn't sensitive to the antibiotic used, the vet didn't prescribe a long enough course of antibiotics(usually 4-6 weeks is needed minimum), or the antibiotic used isn't penetrating enough to get to the infection.

Reoccurrence could also occur because the cause of the head tilt wasn't properly diagnosed. Like if it started out as ear mites and the ear mites then caused a secondary bacterial infection. And if a vet only treated for an ear infection but missed the ear mites, there could be residual head tilt, or vice versa. Though usually with ear mites, it alone won't be a cause for severe head tilt, but just minor head tilt.

Or in the case of toxoplasmosis, reinfection occurring from continued exposure from living around cats.

https://wabbitwiki.com/wiki/Head_tilt
https://wabbitwiki.com/wiki/Encephalitozoon_cuniculi
Medirabbit: ear infection clinical signs and treatment

hi and thank you for the response.

neither of the vets he saw for the prior infections seemed to have any idea what caused the head tilt. the first vet appeared to be prescribing antibiotics just to see if he would respond to that treatment, and since he did, we assumed it to be a bacterial ear infection. the second vet(who i took him to most recently) prescribed him the same antibiotic because i told them he responded to that treatment last time. i had no idea there was a way to diagnose the cause of the head tilt other then, well, postmortem examination. vets tend to have difficulty examining very deep in his little ears, like they dont have the equipment for that or something. i was also led to believe that 2 weeks was the regular duration for antibiotics in these cases, but if that is not long enough i can see the bacteria just becoming stronger.

i will bring the information you provided up with the vet during his visit and see if that helps any. it feels frustrating not to know the cause of the head tilt and to have had some misleading information about it, but its good to learn these things now.

from pictures ive seen online, his case seems to be on the milder side. his head isnt tilted all the way sideways, rather it is more noticeable when he moves around and loses his balance a little. the eye rolling motion is unmistakable though.

thank you again and i will update when i have new information.

 

[JBun]

So xrays or possibly more detailed scans would be needed to check for an inner ear infection. To check for e. cuniculi, a blood titer is done, and then it checks antibodies, not necessarily if the infection is active. Anyways, this is how it used to be checked. I haven't researched lately to see if anything has changed. And these things do add to the cost quite a bit, so sometimes owners opt to just treat based on symptoms. And vets will often treat for both possible causes of e. cuniculi and inner ear infection, when they haven't found a definitive cause. So fenbendazole for EC, a rabbit safe antibiotic, and meloxicam to reduce inflammation. And the antibiotic is usually 4 weeks minimum.

If you look at the first link in my post above, there are also links there to some head tilt support groups that you might find helpful, and some other head tilt links. Onthewonk has some good personal stories about successful head tilt treatment.

If you're wanting to try and find a more knowledgeable rabbit vet, you can check the HRS list, though I also check reviews and other rabbit owner recommendations when looking for a good rabbit vet.

https://rabbit.org/veterinarians/

 

[butte]

update: i have called every rabbit vet in the city, including his most recent vet, and none will be available until tomorrow. unfortunately the one available tomorrow does not allow owners to go in with their pets due to covid restrictions so i will be unable to discuss much with the vet prior to his appointment. i cant express my disappointment, in the city i used to live in there was always at least an emergency vet available. so my little boy will have to wait until tomorrow to receive any treatment besides the meloxicam i gave him this morning. i just hope the vet tomorrow is decent and treats him well. i have never taken him anywhere that wouldnt let me see what they were doing to him. the reviews are not great but i have no choice.

thank you again for the info and the tip about head tilt support groups

 

[butte]

another update: i was able to get an appointment today and have a new vet see him. the vet thought on examination that it looked like an ear infection since it wasnt the most extreme case she had seen. since they wanted to give him antibiotic i suggested he be on that for 4 weeks, so they prescribed that as well as a bit of meclizine for his dizziness. the vet said his tooth is due for a trimming but it doesnt seem like there is an abscess.
he was very well behaved and patient at the vet (as usual!) despite being disoriented. he ate and drank a bit when he got home.

i know the vet didn't do any xray or blood test but i feel a bit better now that i was able to find a vet who would actually see him. its the best i could do for today. hopefully that treatment is what he needs, will update on his symptoms.

 

[JBun]

What antibiotic did the vet prescribe? Is it daily meloxicam he's on for his arthritis and do you know the dose and also his weight? Those would be the main two meds I would want to start with, when having a rabbit show signs of head tilt and nystagmus.

 

[butte]

What antibiotic did the vet prescribe? Is it daily meloxicam he's on for his arthritis and do you know the dose and also his weight? Those would be the main two meds I would want to start with, when having a rabbit show signs of head tilt and nystagmus.

the antibiotic is baytril. the original vet said the dose of his meloxicam for his arthritis could go up to .5ml daily if needed, but its better for his liver if he can go on .3 and/or alternate days. since his pain seemed managed well on the .3 dosage i was having him on that, but i gave him the .5ml today since he was having more discomfort from the head tilt.
i don't remember his weight today since so much else was on my mind, but they said he was a healthy weight for his size. so my guess is somewhere around 2.5 lbs? he's just a little guy.

 

[JBun]

Yeah, 0.3-0.5ml(0.45-0.75mg) of the 1.5mg/ml suspension would be the recommended dose for a bun that's just over 1kg(0.3-0.6mg/kg,once or twice a day). I just thought I would check, as many inexperienced vets(with rabbits) will give the dog dose, which is far too low of a dose for rabbits who have a faster metabolism, and an insufficient dose wouldn't be doing much good.

For now, I would give the meloxicam every day and go for the higher dose once a day, or 0.25-0.3 twice a day for a week or two(possibly longer if the higher dose is helping), to help bring down inflammation caused by the infection, as the inflammation can contribute to the symptoms worsening, and also cause permanent cell damage. But that's just what I would do.

And if you don't notice any improvement after a week on the antibiotic, but certainly if there isn't much improvement by the second week, or a worsening of symptoms, I would suggest discussing changing antibiotics with your vet. If your vet is fairly certain it's an ear infection, the best antibiotic I've found for difficult infections in rabbits(depending on bacteria involved) is azithromycin.

Azithromycin cleared up a stubborn retrobulbar abscess in one of my rabbits after her badly infected eye had been removed. And improvement occurred after only a few days of starting it. Though do be aware that it can cause very severe digestive upset in some rabbits, so that needs to be carefully considered before deciding whether or not to try it. There are other safer antibiotic choices if you end up needing to switch from the baytril and don't want to risk the azithromycin.

 

[butte]

i think thats a good idea for the meloxicam dosage, especially if it prevents cell damage. i was already thinking of doing that to keep him at maximum comfort, since he will be more likely to eat on his own that way as well.

definitely i will monitor his condition over the next week and keep that in my back pocket as a next course of action. the digestive upset thing sounds worrying, do you mean that it will make his appetite go away? i can still force feed him if necessary but i hope his appetite stays up.

speaking of force feeding, its been a bit of trial and error figuring out how to schedule that out. if it came to that, what would you recommend as an amount/frequency of critical care feeding each day for a bunny his size?

sorry for so many questions btw! but im sure you know well how important the details are...im more uninformed than i thought i was

 

[JBun]

For my rabbits that had been treated with azithromycin, the most I saw with them was some initial stomach cramping with two of them, but then after a few hours it was gone and they were back to normal. But I have read of a few rare instances of severe upset causing true diarrhea, which is always a serious condition with rabbits. And if that happens the antibiotic has to be stopped immediately, the diarrhea treated and the rabbit hopefully stabilizes.

It's a very effective antibiotic, but there is the rare chance of a reaction, so that has to always be factored into the decision to use it or not. You may not even need to worry about that if the baytril is effective. But if it isn't, I just wanted to share the info in case you find yourself in a situation where the antibiotics aren't working and you need a more 'heavy duty' one.

I would usually do feedings every 4-6 hours, and amount is generally 8-12ml/kg.

https://rabbitwelfare.co.uk/rabbit-health/medical/syringe-feeding-guide/
https://wabbitwiki.com/wiki/Medicating_your_rabbit

 

[butte]

thats good to know and something that i will keep an eye out for if baytril doesn't work out.

i may well need to forcefeed him, i've noticed his poops getting smaller and he didn't eat all his pellets last night. usually he gobbles them up like a treat.

 

[cuhurun]

Three weeks ago one of my girls developed e-cuniculi and was rolling her eyes, staggering in tight circles and beginning to tilt her head.
I took her to the vet the following morning and the vet gave her drops of antibiotics directly into her ears, rather than orally. I followed this up by continuing the process at home for five days and now the problem is resolved, little girl is absolutely fine.
Thankfully, my vet is superb and has a really good holistic approach to animal welfare and treatment and, unless as an absolute last resort, avoids giving antibios to rabbits orally or intravenously.
This was the first time I'd seen this method of treatment used... and so far so good.

 

[butte]

just got done giving him medication. his head tilt is way worse. when i picked him up he got so disoriented he couldnt figure out how to stand again when he got back on solid ground. he rolled around and made sad little crying sounds. i had to put him on his feet and hold him there til he got his bearings. very distressing to see, it's definitely worse than the other two times he has had it.
last night he ate a bit of grape when i offered it to him and he pooped a tiny bit since then, but since he isn't interested in anything else i think it's safe to assume he needs forcefeeding. so that's fun.
i keep telling myself its only been a few days but it is really distressing to see him like this.

 

[butte]

we padded his pen with blankets so that he doesnt hurt himself from falling over and rolling. i want him to be able to drink water but i am not sure he will manage this, so i think i may remove his water dish from the pen so he doesnt accidentally drown himself in it, and give him water from a syringe. is this a good idea?

 

[JBun]

If he can't drink, then yes, he would need fluids syringed, along with the critical care feedings. Though I would usually just make the critical care mix more of a soupy consistency, so my rabbits would get the fluids they needed and I didn't then have to syringe water separately. When syringing, you want to make sure you go slowly with small amounts, so he has time to chew and swallow, to help reduce risks of aspiration occurring. If you still think you want to keep a water dish in there, try a heavy crock that couldn't easily be tipped over.

Moving them can cause disorientation. If you can medicate by keeping him on the floor, that would probably work better, and may help him keep his bearings better. That link I shared above on medicating, shows a method of doing this with the rabbit in between your calves while kneeling on the floor.

If you're finding the meclizine isn't helping with the dizziness very well, benedryl(diphenhydramine) may be another option. Some of the vet books say it can be used for nausea when a rabbit has vestibular disease(head tilt), though I've only ever used it for rabbits with respiratory infections, so couldn't say if it really is helpful for head tilt or not.

https://wabbitwiki.com/wiki/Common_drug_dosages_for_rabbits#Other_drugs
Another thing that some owners say helped their head tilt rabbit, is massaging the neck muscles. So may be worth looking into. Also, here's another resource with info on helping rabbits while they have head tilt.

http://www.disabledrabbits.com/head-tilt.html

 

[butte]

this morning i got up to find him limp and barely responsive, so i rushed him in for an emergency appointment. they found him to be stable, but they gave him subcutaneous fluids and took some samples from his inner/outer ear to see if they could identify what was causing his infection and change course if necessary. turns out he has a very bad case of ear mites after all, so they put ear drops in his ears and kitten revolution on the back of his neck and sent him home with some of those.

the vet seemed to believe that he is in the stage of "it gets worse before it gets better" and to continue treating him as i was before with the addition of ear drops. i may have to purchase some products for his eyes as well.

i just hope that he makes it through this because he scared me half to death this morning...9 years old is i guess old for a bunny but id like to think he can live longer.

 

[butte]

a few positives: he still eats his critical care at feedings eagerly, he has started pooping again. today he did a cecotrope and when i offered he ate it. he tooth purrs when petted, and his "up" eye seems bright and alert.

negative: he seems unable to stand. i can prop him up between my legs so that he's on his feet and he seems to like this, but by himself lacks the strength. he can stretch his back legs out and kick them, and he washes his front paws. but other than that he doesnt move except to roll back to laying on his right side when moved from this position.

his head started doing some slight jerking motions this evening and i am not sure if it's out of discomfort or if there is something neurological. it's not constant, but from time to time he does it.

 

[JBun]

Hopefully he's getting enough of the right meds and treatment now, that he'll start to show improvement. It's difficult with old buns, as it seems like everything starts going wrong with them and it can be hard to maintain that good quality of life for them in their final years. But I think you're doing all you can for him. All we can do is try our best for our buns and hope for the best.

I'm not sure about the jerking motions. It could be neurological since this is what head tilt is. It could be something like a seizure. But sometimes a small jerking motion can just be hiccups.

 

[butte]

Hopefully he's getting enough of the right meds and treatment now, that he'll start to show improvement. It's difficult with old buns, as it seems like everything starts going wrong with them and it can be hard to maintain that good quality of life for them in their final years. But I think you're doing all you can for him. All we can do is try our best for our buns and hope for the best.

I'm not sure about the jerking motions. It could be neurological since this is what head tilt is. It could be something like a seizure. But sometimes a small jerking motion can just be hiccups.

we took him to the vet again today because we were unsure the cause had been investigated properly, and were surprised to learn that prior bloodwork did indicate that he might be fighting an e. cuniculi infection. the vet prescribed him panacur but did not seem optimistic about his condition. i asked him for the timeline and he said that if we didnt show any improvement in the next 15 days, it would probably be best to consider euthanization. i'm not sure what you all think but that seemed fair to me. the last 5 days have seemed like an eternity and his quality of life is important.