Hershey and Horner’s disease

[kralspace]

Seems like a bad time for a lot of our bunnies   ;-( Does anyone else have any experience with Horner’s?

I just got home with Hershey,  Dr. Erving said she has Horner’s disease (going to be doing some reading tonight for sure). She described it to me as a neurological problem with paralysis of the nerves on the left side of her head going all the way from her ear to her lip.

I had called the clinic late last night to make an appointment for today because Hershey just didn’t look quite right when I got home, not sick, just a bit off. I called back at 5 this morning after checking on her and luckily Dr. Erving answered the phone. I told her it looked like Hershey had had a stroke during the night. One ear was down, the whole left side of her face was strange and she had me bring her right on in.

Her entire left jaw was packed with carrot, greens and cecals which is why it looked swollen to me, even the eye. Dr. Erving said the paralysis kept her from feeling that there was food still in there. She said Hershey seemed to have no feeling on that side at all and didn’t react to her touches, not even the whiskers or eyes.

She prescribed some Dexamethasone topical for me to rub on the inside of her ear for a week and then bring her back. They kept her all day to keep an eye on her and by the time I got back after work her face was looking much better and the ear was picking up a bit. They showed me how to clean out her cheek every evening to make sure she doesn’t have food stuck in there and develop an abscess later.

After assuring me that Hershey wasn’t in pain and her condition could be improved and managed, she said it had been a great learning experience for her staff today and that they spent a lot of time examing her because most of the techs hadn’t seen a case before. I was so freaked out I’m just glad she’s pretty ok. They said the medicine would give her the munchies big time and she certainly is chowing down in there. I think we’re both ready for bed.

See how the left side of her face is drooping a little, her ear was all the way back at this time.

 

I changed her bedding before putting her back, look at all the poops!

Hershey before

[Monkeybun]

Oh poor Hershey So soon after losing her mate too! I hope she gets better, sounds like a horrible thing to live with

[kralspace]

thanks Monkeybun, I was so afraid it was going into headtilt I’m almost relieved it’s this instead.I’m really amazed that rubbing a topical on her ears helps the nerves that much.

[bunnytowne]

Never heard of Horners.  Gee.  Another problem    Glad the vet knew what it was.   Sounds like a good vet you have.

I know I have told you b4 I think Hershey is absolutely beautiful gorgeous.  That color.  Wow.  STunning.

So your girl has the munchies.  Will the feeling come back do they know?  I hope she has feeling in her whole tongue so she doesn’t bite it.  Gosh one more thing to worry about. 

How many times a day do you  have to check her cheek for food sitting there?  I hope she doesn’t have a tantrum on you when you tend to her.

[jerseygirl]

(((Hershey!)))

It must be a relieve to you to see her eating and pooping though! I might look on allexperts see if Horners is mentioned… Sounds like you vet is best person to ask anyhow.

I agree BT, Hershey is Beautiful!

Edit: There is mention of it on HRS article but not too much info http://www.rabbit.org/health/tilt.html

[Sarita]

Oh Kathy! I’m so sad to hear this about sweet Hershey! You must be stressed to death! I have never ever heard of this but it does sound like your vet is on top of this and they are caring so well for her. Maybe you should contact Dana Krempels to see if she has any info on this.

[Sarita]

Oh, and please please keep us updated on her.

[kralspace]

Dr. Erving said her tongue wasn’t involved strangely enough, just this big nerve network that runs across the face. I can’t remember everything she said but she was able to definitely rule out that it was a brain problem, ear infection, or hidden abscess. Her eye looked really wierd because the paralysis involved her eyelids and the third eyelid also.

I asked if the food impaction in her cheek was the cause or result of the paralysis and she said the result. That Hershey didn’t know the food was there to finish eating. She said I could either trance her and use a qtip to clean out the pouch or that she is so unaware that you’re touching right there that I could use my fingers to manipulate it from the outside and move any food out of that cheek area.

Thanks for the suggestion about Diana K. I’ll see if she has any info on it.

The munchies are good news, she’s lost a few ounces over the last couple of weeks and the vet said she should certainly gain that back quickly. I remember the first time I saw this tiny rabbit at the Sanctuary. Sarita had just taken her photo and I couldn’t help saying that she was the most beautiful bunny I had ever seen.

[Sarita]

Kathy, did Dr. Erving have any idea what could be the cause of this? Is it just suppose to get better over time? It does sound like she is somewhat better after the day at the vet’s.

[kralspace]

She said she checked for ear infections first thing and they were ok. I forget the other items she checked to rule out a physical cause, she said unless some condition surfaces that it could be pinned to, that it could be idiopathic, (like my son’s epilepsy, no physical reason found, just happens sometimes) I take her back in a week for a checkup.

She said it might get better since it didn’t involve the brain (as in an infection) but if not it was still manageable to give her a good quality of life for now.

It is confusing.

[corpathina]

thank goodness you have a very rabbit-savy vet! vibes to hershey and i hope her condition continues to improve! keep us posted.

[BinkyBunny]

Oh wow, I am so sorry. I am so glad though you are in good hands. I have never heard of this either so this is educational for all of us! I will be doing some research on this too. Please keep us updated!

Hugs to you and healing vibes to Hershey.

[Beka27]

Wow! I have also never heard of this! Sounds like you have an awesome vet who really knows her stuff! Thank goodness!

(((Hershey!)))

Keep us posted on what you learn and how she is doing. I’m interested to hear how this proceeds.

[MimzMum]

I just want to add my healing vibes. (((((((((((hugs for Hershey)))))))))) I’m so sorry you’re going through this so soon after it seemed that Hershey was finally coming back out of her mourning shell. But I’ll pray she makes a swift and full recovery!

[Kokaneeandkahlua]

{{{Hershey}}} Omg I’m so sorry AT least like you said-it could be worse and this diagnosis is almost a relief

There’s a little bit on Horner’s in rabnbits here http://www.veterinarypartner.com/Content.plx?P=A&A=485&S=5&SourceID=43
And on it in general http://en.wikipedia.org/wiki/Horner’s_syndrome

[kralspace]

Thanks for the article, I’m trying to learn what I can. What worries me is she’s still very slowly losing weight despite eating like a horse. Her ear has times when it’s at half mast instead of flat down and she reacts when I touch her cheek so hopefully the steroids are working.

I’m trying to find some alfalfa based pellets like Sarita suggested and she likes the alfalfa cubes that I break up for her so maybe we can gain the weight back. I’ll get Dr. Erving to check her over for any other problems that might cause that, besides old age.

[Sarita]

What about critical care? Do you think she would eat that or maybe you have to syringe feed her a bit each day – I know she’ll love that LOL.

Continued vibes to little Hershey.

[kralspace]

I’ll try that tonight, I forgot I have some in the First Aid kit I got from NTRS.

Jackie ordered me a 5lb bag of Oxbow’s alfalfa pellets to go with my orchard hay, so I’ll run up to Dallas Saturday and pick it up. I’d bring Hershey, but she really hates being in the carrier and it’s a 3 hour ride.

Regarding the syringe feeding? Yea, that’s going to get me a stitch or two definitely. Dr. Erving has always said what great teeth Hershey has, I wonder if she’s nailed the vet a time or two…lol

that paragraph mentioned in the article describes it to a tee if you add in the ear falling down:

“If the branch of the facial nerve that passes through the middle ear is damaged it can cause a drooping lip and ear, drooling and a decreased or no eye blink reflex. If the cranial nerves CN III, IV or VI are damaged, Horner’s Syndrome results. Horner’s Syndrome is characterized by a drooping eyelid, sunken eye and relaxed third eyelid (where it stays “up” over the corner of the eye and can’t retract) and a pupil that is more constricted than in the other eye. In some cases the eye becomes very dry because of loss of the ability to blink and replenish the eye with tears or because of damage to the nerves affecting the tear duct. Occasionally, the drooping eye and ear from facial nerve damage might mimic a mild head tilt. However there is NO loss of balance.”

[Sarita]

Yeah, I don’t think you need to stress little Hershey for that ride out there – anyway the vet is the best person to help with her treatment and diagnosis.

Have you done any bloodwork on her?

[kralspace]

not yet. I’ll ask Thursday. She said she should pick up weight once her jaw was working right again, or she could at least feel there was food in her mouth that needed chewing.

[Sarita]

I also PM’d you…check your BB mailbox.

[Deleted User]

Healing vibes for Hershey! A learning experience for your veterinary clinic? — You may want to enter Hershey into the HRS health database as well then.

…maybe don’t give Hershey that ‘stern talk’ about getting along then… just get well wishes.

[kralspace]

what is the HRS database? sounds interesting.

Dr. Erving was very familiar with the Horne’s, but only one of her staff techs had seen a case before so she was excited to show them a ‘classic’ case that included the ear, eye, jaw, lips and even the whiskers. She said it can mimic head tilt but is treated differently. Glad someone was happy about it. (just kidding about that, she devotes a lot of time to teaching)

[KatnipCrzy]

healing vibes for Hershey- but I don’t know anything really about Horner’s disease- so no input here unfortunately. 

I want to save up and buy a rabbit medical textbook from Amazon- like ones the vets use- but they are kinda expensive- like over $150.  ANd I am pretty sure it does NOT mention the Cow Poop Syndrome that Schroeder is being treated for as by advice of Dana Krempels anyway.

[kralspace]

Yea!!

Sarita kindly sent me a bag of Critical Care and I mixed a teaspooon of baby oatmeal with apple with a teaspoon of her regular applesauce and added her Baytril and a half teaspoon of CC to see if she’d eat it.

She smelled it coming and darn near attacked me! Definitely loves it. Not sure how much I should try to get her to eat tonight. Outside of her carrot, she turns up her nose at the veggies now and eats pellets, a bit of orchard hay and lots of water. Normal looking poops everywhere thanks goodness.

Maybe mix more CC and less applesauce?

Her front legs and paws are pretty damp with her drooling, I’ll try to wash them a bit when I check her cheek later tonight. The feeling is definitely coming back in the jaw area because I’ve been massaging the food out without her seemingly noticing that I was touching her. Last night she nailed me good and is responding to touches in that area. The left ear is coming up a bit too.

The lip and nose seem to be the most affected now. You can see the left side struggling to keep up with the right when she eats and she slobbers a bit. Looking a bit grumpy and rumpled, poor baby, but hanging in there.

I sent a question to Dana K the other day, but no word back yet. A drop of Rescue Remedy did wonders last night when it came to catching and treating her. (after the bite that is)

Thanks for all the healing vibes!

[kralspace]

I fixed her another helping with more CC in it and she ate that too! In some of the photos you can see how her lips don’t quite line up and I caught her licking her lips. She’s looking much better tonight!

 

 

[MimzMum]

I was thinking why the Dexamethasone looked familiar. It’s the steroid they gave me while I was taking chemo treatments to keep me eating. As a topical, I don’t think it has the same effect. Funny thing was, the first round of chemo actually made me feel hungrier than I usually did, which was whack. 0_o
Continuing healing and better eating vibes for Hershey, sweet little bun! ((((((((((((((((((Hershey))))))))))))))))))) And uplifting vibes for you! (((((((((((((((((((Kathy)))))))))))))))

[BinkyBunny]

What a nice thing that Sarita did and I am so happy that Hershey is eating the mix right up, and looking better. Glad to hear how Rescue Remedy worked. I haven’t ever tried that, but I’ve heard positive things.

When Dana does answer, definitely keep us updated with her response.

Also, you really are lucky to have a vet that is on top of this disease. I will also asking my vet about it just to educate myself more and I will share anything I learn.

With this disease, what happens next? I mean what kind of long-term healing and/or management takes place?

[Sarita]

I’m glad little Hershey likes the Critical Care. She’s looking good too. I’d love to hear Dana’s response as well. Continued healing vibes to little Hershey.

[kralspace]

Dr. Erving said the steroid might help repair some of the nerve damage, we’d just have to wait and see. She said it’s like Bells Paisley (sp) in people, that it can happen for no reason and disappear on its own many times.

We go back Friday and I’m anxious to see what she says. She seems to be adjusting her eating motions to the way her lips work now. That last photo of her from the front shows how they look now. She wasn’t moving them at the time I shot it, that’s the way they are.

She attacked breakfast this morning even though it was half CC (a heaping teaspoon) I added the applesauce and oatmeal and then water until it was a nice consistency.

thanks for the vibes, all.

[Sarita]

I can see in the last photo where the side of her little face is drooping. Glad she is chowing down on her goodies too.

Make sure you put the CC in the freezer – I forgot to tell you that. It will make it last longer – past the expiration date which I believe is 07/10. I’m not sure how much longer but that’s what Oxbow does suggest.

[kralspace]

Thanks for the freezer tip, I’ll text my son to do it.

The funny thing about her lips is that the side that is affected is the side that’s drawn up now, not the sagging side. At first it drooped, the last 3 days the lip and right around there seems to have pulled back. It’s her right side when looking straight at her in the photo. A few times last night the lip was pulled back enough to see a bit of the (very sharp) teeth on that side. Wonder if the steroid is doing that or the paralysis is changing?

[Kokaneeandkahlua]

It could well be that there was an initial change and then as the nerves recover (nerves do regrow-and they do form new connections after trauma) that things are changing. It could also be over compensation on her part? I would suspect that things will not be as bad as they were initially after some time Let us know how her visit goes and what Dana says

[Sarita]

Any updates? Did you see the vet yet?

[kralspace]

I dropped her off this morning so I won’t know until after work. They call if there’s something serious but this saves me missing a couple hours of work. They can take their time with her and I get to talk to the vet after hours when she’s not so rushed.

Her weight is holding at 2.22 lbs so the critical care is great! The other bunnies get a bit miffed when they see her getting service a bit of toasted wheat bread with mashed banana, baby oatmeal and applesauce.

[Sarita]

I always drop off to the vet as well..so much better all around really. Hmph…some buns get all the special treatment – not fair :~)

Let us know what she says when you do talk with her.

[kralspace]

I’m glad to hear that, I feel like a bad bunny slave if I don’t stay there, but they keep her carrier in a very quiet room and might examine her a couple of times during the day. Or with Toby, they just like to cuddle him on breaks……he’s pretty spoiled

[kralspace]

The vet said Hershey’s progressing well. Still some paralysis but she was getting some response from her entire face, some spots more than others. Still no sign of what caused it but she said that she could get most of her sensation back eventually. Her last dose of steriods is tonight so we’ll see what happens.

Hey Mimzmum, I remember when my mom was undergoing chemo for cancer and she got a lot of steriods too. They made her hallucinate and see people. We’d come in and she’d be just fussing at ‘someone’ who was sitting on her bed helping themselves to her lunch. I wonder if Hershey’s seeing any bunny ‘visitors’?

I run to Dallas tomorrow to pick up a box of Orchard hay and alfalfa pellets so we’ll just keep working on her appetite for now. I’m just so thankful it wasn’t any thiing more serious and we have a good vet. Thanks everyone for all your healing vibes

[MimzMum]

Oh that must’ve been kind of horrible for your mom. 0_0 I didn’t see any strange visitors, but on my second round of chemo, since they changed the medicine, I did get very depressed and that’s when they put me on SSRI’s for a few years. I eventually weaned myself off them, but yeah, sometimes steroids can mess with your head. Hence why I don’t understand how they are worth taking voluntarily. (like in sports)

That is SO strange that you mentioned Bell’s Palsy! My best friend since high school had that as a kid. She was swimming at a meet and someone nearby hit a telephone pole with their car and the power went out in the pool room where she was, letting loose a stream of chlorine gas into the water right in front of her since she was near a venting system. She got a face full of it and had to be rushed to the hospital and developed this palsy. She spent weeks in an oxygen tent and to this day she is not as coordinated with her left side (the affected one) as her right, but she came all the way back from it. So I have good hopes Hershey will be fine and fully recovered soon. (Although she may drop her lip when you come by to see if you’ll bring her another slice of toast and applesauce…lol!)

[Sarita]

I’m glad little Hershey is recovering. Still want to know what causes this though…Continued healing vibes to little Ms. Hershey.

[kralspace]

I finally got an answer back from Dana, here’s what she wrote,

 

Expert:	Dana Krempels, Ph.D.
Subject:	House rabbit with Horner’s
Question:	I have an older spayed girl (8-9) who I took to the vet because I thought she’d had a stroke. One side of her face, eye, lip all looked really  strange, ear flattened down, etc. My vet said it’s Horner’s and affects the nerve from the ear all the way to the lip. We’re treating her with a steroid and she’s doing better, but I was wondering what causes that? The vet couldn’t find an infection, injury or anything. Her cheek was packed with food that she couldn’t even feel was there. I haven’t found much on the subject so I thought I would ask, thanks so much for your time.
Answer:	Dear Kathy, I have heard of a couple of cases of *suspected* Horner’s, but this is usually secondary to a primary condition, such as an infection.  This article has some information that might be helpful: http://www.rabbit.org/health/tilt.html Kathy edit: here’s the info from the article mentioned above: “If the branch of the facial nerve that passes through the middle ear is damaged it can cause a drooping lip and ear, drooling and a decreased or no eye blink reflex. If the cranial nerves CN III, IV or VI are damaged, Horner’s Syndrome results. Horner’s Syndrome is characterized by a drooping eyelid, sunken eye and relaxed third eyelid (where it stays “up” over the corner of the eye and can’t retract) and a pupil that is more constricted than in the other eye. In some cases the eye becomes very dry because of loss of the ability to blink and replenish the eye with tears or because of damage to the nerves affecting the tear duct. Occasionally, the drooping eye and ear from facial nerve damage might mimic a mild head tilt. However there is NO loss of balance. “ Dr. Brown specifically mentions Horner’s Syndrome in this article.  But there’s not really much out there on this condition in rabbits.  It’s far more common in dogs. I’m glad the corticoteroids are working, and that bun is better.  I hope she continues to improve. Dana Dana Krempels, Ph.D. University of Miami Biology Department H.A.R.E., Inc. of Miami, FL dana@miami.edu House Rabbit Society: http://www.rabbit.org Rabbit health: http://hare.bio.miami.edu *Your feedback is appreciated!*

 

 

 

 

[jerseygirl]

It does seem to be a secondary condition. In humans & one thing I read on dogs, it mentions a lot of other things that can cause Horners. One thing I saw was it being related to something going on in thorax or neck area. Also, ear infections, brain tumors, abscesses as your vet has already investigated. I also came across thyroid growths and other cysts being possible causes. There were many possible causes as I said. Does your vet want to do more scans?
I do wonder about things like teeth and molar roots impinging somehow on the nerve. Then again, could it just be Hersheys age?

I came across this science paper using the alternate name Bernard-Horner syndrome. I’m not sure what is discusses as I can’t access it and it’s in italian anyway. If you put this in a search engine, it brings up all the connections to this paper. “The Bernard-Horner syndrome in the framework of the oculo-auriculo-nasal sympathicoprival syndrome of the rabbit” Quite a mouthful!! Just from the title, the connection to eye-ear-nose is interesting. It may just be though, Horners as a result of sectioning part of another nerve system (sympathetic nerve) which came up alot in the stuff on Horners in humans.

[Sarita]

Well, she unfortunately doesn’t know much. Maybe that’s why she took longer to answer. She’s always very nice in her answers too.

How is Ms. Hershey today?

[MooBunnay]

Sorry I am late to joining this thread – Hershey is so lucky to have you and a great rabbit vet to take care of her. I’m so glad to hear that she has been eating well and is holding her weight. She looks so cute in her pictures, Brian said that her lopsided-ness made her look extra disapproving, maybe it is because she knows you are sneaking meds into her food I hope she keeps feeling better, she is in very good hands with you!

[kralspace]

I feel very lucky to have Dr. Erving down here. Not that I didn’t love Dr. Effie and the way she took care of Pringles when I had her spayed up in Dallas, but it sure is nice to have someone only 15 miles away. She’s Aggie through and through, her clinic is done in gray, white and maroon…..lol

I would like to see how you get a vet listed with the House Rabbit Society. I don’t think we have any listed down here in the Waco area. I had been to about 6 vets with the bunnies before I found her and none of them really had any experience compared to her.

Hershey’s seems to be thriving on her diet, much to the disapproval of the other bunnies who are feeling very deprived. The ear’s still at half mast but she seems to have a lot of her feeling back except maybe the lip on that side, but she seems to be adjusting well. She’s a tough tiny girl.

[kralspace]

Yay! I weighed Ms Hershey today and she’s gained from 2.1 up to 2.9 lbs. When I hold her she still feels very bony but at least she’s gaining back. She still gets a helping of applesauce/baby oatmeal with her Baytril, probiotics and CC twice a day and gets very cranky when I come home and just give everyone a handful of orchard grass to tide them over til I can sit down for a minute.

[jerseygirl]

Posted By kralspace on 01/24/2010 07:01 PM
II would like to see how you get a vet listed with the House Rabbit Society.

Good question.  I wonder too if they do routine updates of the referral list?  I guess you could shoot of an email to your local chapter and ask. Or contact the HRS HQ.

[Sarita]

I used to do the HRS vet list ages ago when I was an HRS foster/educator. I would email Stan Gove who is an educator/foster in Austin I believe, he’s on the list of contacts and ask him. That’s what the HRS site recommends.

[Sarita]

How’s Hershey doing?

[Author]

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