When to quit treatment

[jakeadair2]

Starting in July, one of our two bonded rabbits, Buster, has been having medical issues. He developed a cataract in July. We did not treat him for anything at the time.

 Then, probably early october we noticed a head tilt, which we had dealt with before. Of course, on saturday night, so we got “emergency” meds in the form of baytril and oxybendizole, which we gave him for two days until we could get into our rabbit vet. This was to treat either ear infection or EC, which we know are two common causes of head tilt. 

 Went to the vet that next week and she saw that his ear was definitely infected, and so we discontinued the oxybendizole and treated with oral baytril and a baytril otic in the ear. We did this treatment for three weeks before we stopped it. Buster seemed pretty good, if maybe a little less active (his final three treatments were done by a rabbit sitter because we were out of town, and so we aren’t entirely sure they were done or done properly).

 As he was still acting down towards the end of october we took him to a new vet closer to home because I wanted to have his teeth looked at, he was not eating hay and eating only pellets, so I thought maybe his teeth had grown too much. He was also not using his litter box anymore and just peeing wherever. The vet told us to continue the baytril otic, though not the oral baytril, and gave us a metacam dose that came out to roughly 1.2mg/kg a day for him.

We did this for another week and took him back to the vet, who said she saw no signs of ear infection. We took him home, and immediately he started rolling uncontrollably for the first time, where before he had only a minor tilt and a little less active. We gave him the metacam dosage again even though we were planning to discontinue it, and that seemed to help him. This got us thinking, maybe he had EC all along and it was being treated by the anti-inflammatory metacam.

 So, we went to another vet the next day at the “top” rabbit clinic in our city. He gave us more oxybendizole and metacam (meloxicam this time). We treated with that for a week, .1 of the oxybendizole daily and .25 mg/kg of the meloxicam daily. He wasn’t improving, so we called our old vet in St. Louis, who had worked with us and we think is excellent. On his advice, we decided to continue trying some antibiotic treatment. He said ear infection is much more common and likely than EC, and it may be that the 3 week course did not fully cure the infection even if there were not visibile signs of infection.

So for the last week we have been doing .1 oxybendazole, .25 metacam, .and basically 6 mg/kg of baytril once a day. We have also done intermittent critical care throughout the whole process as Buster has lost weight.

So this week has been up and down, but he is definitely not getting better, and today is his worst day yet. He still eats any fresh greens, canned pumpkin, some pellets and hay, and drinks water most days although today his balance has been so bad he only drank when I held his mouth above the water bowl. Today he barely moves from wherever I put him and often falls when he tries to move. Other days he has moved some but not a lot.

Our thoughts on what we can do are up his meloxicam dose (I gave him an extra one today), up his Baytril or try a different antibiotic (especially since he was on it for 3 weeks already), get him some meclizine (it seemed to work for his partner Binky), start using an antibiotic ear flush or otic topically in the ears (which we have done before), do nothing, or… think about his comfort.

So my question for people out there, is what would you do to cure him? At what point do we start accepting that he will not get better? What do we do to make life easier for him and for his partner Binky (who has been distressed during the last week especially)?

For what it is worth both Buster and Binky are about 5-6 year old Holland Lops, Buster still seems to enjoy food and does try to eat and drink regularly and sit with Binky some (as I am writing this he went for a drink of water on his own which makes me so happy). He just cannot seem to walk or stand (almost seems like weakness as much as balance) and he has one eye completely covered by a cataract, and he seems to be getting worse rather than better. 

 

Thanks for any tips

[Bam]

This is difficult, obviously. that he seems to enjoy food is important though, since an appetite says a lot about his quality of life. How long to treat will depend mostly on this, imo.

The bendazoles are slow-acting meds, and (for fenbendazole, at least) a course of 28 days is the minimum standard treatment for EC. It has been shown that Baytril has some effect against the EC parasite as well, so it’s very good to give both the bendazole and Baytril at the same time.

both EC and ear infections can need long-term treatment before you see any real improvement. So what it comes down to now is imo how you think he is coping. Will to live, appetite, interest in social interaction, if he can keep weight on, if his tummy works well, etc. The Ec parasite can (as you know) affect any part of the brain, so you can very well have both hind-body weakness and balance.issues at the same time. And EC can cause cataracts, if the bunny was infected in the womb.

If you suspect EC, I think you should probably treat Binky as well. Standard preventative treatment is 9 days of fenbendazole (Panacur) every 6 months.

[jakeadair2]

Ya I think today has been the first day where I don’t think he looks “happy” overall. He still eats and tries to walk around but fails and eventually just seems to sit somewhere and give up on moving. He will stick his face in a pellet bowl and sleep and eat off and on, just looks different from even the last couple weeks. Should I be switching to fenbendazole, or does the oxybendazole do the same thing?

 

I think we will give him a few days to see how he looks and maybe increase dosages, but its just so hard to watch and I think he is getting tired himself. Crazy to think about how quickly things change, it was just Wednesday last week that we thought he was really starting to look better. 

[LittlePuffyTail]

I’m very sorry to hear your bunny is so unwell. I don’t have any helpful advice but wish you the best and want to offer some (((Healing Vibes))))

[jerseygirl]

Sending some {{{vibes}}} for Buster also!

It can be very up and down for them with this condition. You are right, it is tiring for them and some days they will seem much more flat then others. I think if I were seeing that in consecutive days and them not wanting to eat or starting to show pain, I would reassess continuing treatment.
When one of my bunnies had head tilt, I decided I’d do a full month of meds (anti-inflammatory, panacur, baytril) and if no improvement, I’d consider having her put to sleep. I was also aware that some other owners saw most of the improvement happen after the round of meds.
The first 4-5 days she didn’t want to eat so it was more about managing stasis. She also lost weight during her illness. Then her appetite returned but by this time she was lying on her side only and going into rolls. By about the third week I think it was, she found her feet for short periods of time, but head very tilted. She eventually was able to drink from a bowl herself and I could just place food in front of her instead of hand feeding her greens. She was separated from her companions furing the worst of it all. After the month, she was able to go back in with them, but she was weak and still had head tilted, but was independant of me. Over the coming months she gained the weight and straightened up completely. She was healthy for 18 months afterward.

I only recently cared for a rabbit that had a relapse of head tilt. He was 8 or older. For him, he was not making the improvements his owner had seen during his other episodes of heat tilt. His mobility was not coming back and he was eating too little to really live on. His owner made the decision to let him go due to his age and condition.

It is very individual. Some rabbits make a full recovery, some get better but with some residual head tilt or altered mobility or incontinence, and for some, everything takes it’s toll.

I know how distressing it is to see them like this. The fact that he has had some improvements is promising. It may be as the vet said, that a longer course of the meds was needed. They can be really stubborn infections!

What did the vet say about the eye? Does he think it’s related?

Did Binky also have head tilt at some stage?

[vanessa]

Sounds like E.C. I’ve had 2 bunnies with it. One was euthenized, the other pulled through. 9 days of fenbendasole twice a year is definitely recommended for preventative AFTER exposure/symptoms. While your bunny is sick, the treatment shodul be 28 days of fenbendazole, plus antibiotic plus anti-inflammatory. If baytril is not doing well, chloramphenicol might be the next option. I used ivermectin with every treatment of fenbendazole. It is considered expiramental for E.C., but I noticed improvement after each dose, in conjunction with the other meds. I used 1 dose (dose per body weight from medirabbit), and a second dose 10 days later. Every 6 months, I include the 2 doses of ivermectin with the 9 days of fenbendazole. I woudl give this a try before making the desicion to euthenize. My bunny Lancelot was completely paralyzed with E.C. I was syringe feeding him for 2 weeks. I sat him up in a donut coz he couldn;t hold himself up. Not even his head. Today is is hopping around like normal. He doesn’t have hsi bladder control back, and hasn’t eaten any hay since July *when he got sick), and I have his teeth filed more often, but he is otherwise back to normal. It took a month for him to be aboe to walk again, and after 2 months he was out of diapers. If I were you, I would tell the vet what treatment you want to try, or find another vet. I’m suprised that the first symptoms didn’t prompt fenbendazole. You can get fenbendazole over the counter, and weigh it out for yoru bunny’s weight.

[vanessa]

I would also ask the vet if he/she thinks yoru bunny needs an antibiotic that will pass the blood/brain barrier or not. The deeper the ear infection, the more likely you’ll need an antibiotic that passes the blood/brain barrier. I used chloramphenicol on both my bunnies. (I was actually given SMZ for the second and chloramphenicol for the first, but when Lancelot tok a turn for the worse and got all paralyzed, I swapped the SMZ for chloramphenicol. It is the ear infection and dizziness that contributes to the paralysis, together with nerve involvement. So strictly speaking, paralysis is inability to move. Lancelot’s case coudl have been that from nerve damage, or from sheer dizziness. Either way – Lancelot was on his side, not moving a muscle.

[jerseygirl]

Regarding oxibendazole, if he’s already been on it for a week, I don’t know if it would be worth switching to fenbendazole. Really a question for the vet… Both oxibendazole or fenbenzole can be used. Albendazole should be avoided.

[jakeadair2]

Binky did have head tilt, it was bacterial infection treated with baytril orally and topically (a wash), plus meclizine. She got better in about 2 weeks. 

The vet thought the eye could be from EC infection in that eye, but didn’t know for sure. I think we are going to try a few new meds for at least a week and look for improvement assuming he continues to eat and show signs that he wants to live. He is not as old as some, and I suppose is it comforting to know that other rabbits have been basically immobile for periods of weeks and made recoveries. 

Thanks for your response!

[jakeadair2]

Thanks for your comments, again its good to know recoveries have been made even when they take longer time. Do you think the oxybendazole doesn’t work? Or that is just isn’t working in this case? Or that we should try the fenbendazole and ivermectin (which I take it are both just different parasite meds) in addition to the oxybendazole we are using?

[jakeadair2]

Just to update:

Came down this morning unsure what to expect, Buster was eating pellets from his bowl. He can’t really move well but can kind of flop/roll/rush in directions and eventually get his feet under him and balance. He does this by leaning his head into the pellet bowl and resting it on the pellets while he eats. I have seen him yesterday drink water on his own from the bowl, though he fell/rolled through the bowl a few times and I would dry him off and hold him steady over the water. We also syringe him some water with critical care, feed him canned pumpkin and wet veggies throughout the day, so hope his water intake is sufficient. 

This morning he ate the lettuce I put in front of him pretty well, though his legs splay out under him and he doesn’t exactly “stand” as he does it. This leg weakness seems different from dizziness head tilt we are used to, and I wonder if it is EC or just his own reaction to being dizzy?

Anyway, I placed him back in the bed we have made for him (a box with a blanket in it) and he laid there and munched on lettuce on his side until I left. Waiting to hear back from our vet (we always have to leave voicemails), and my wife will probably pick up new meds today. 

On that note, I think we are looking for a new antibiotic (chloramphenicol is all I’ve seen mentioned?), adding meclizine, and asking about increasing his dosages to be more aggressive in those two and the meloxicam and oxybendazole. At some point should we switch to Fenbendazole? We may ask about the ivermectin too. 

Thanks to everyone for your tips and thoughts. 

[jakeadair2]

I want to ask as another question, as I haven’t been able to find a good answer: with EC is there a time when it is “too late?” Like the parasite has infected his brain too much and even if we get the proper treatment too him he will not regain functionality? In that sense I guess is it different to be weak/unable to move because of a parasite in your brain as opposed to dizzy from an infection in your ear which can clear up?

[Nev]

I’m so sorry this is happening for your family. The poor baby.

I can offer no advice from the medical side, however from this fur parent point of view, enough is enough when it’s obvious the companion no longer finds joy in life and things previously loved, or is suffering with no reasonable relief or hope. I won’t give up on my babies if they want to fight and there is hope. Sometimes there isn’t, and we have to let go. I was once set home from the vet with an elderly kitty who was to die gently at home, but she bounced right out of her carrier and lived another four years, mostly happy and active until the last three days of her life. She wasn’t suffering, I had the office on call if they were needed, but she still was affectionate and wanted to be loved, so I just knew she still had things in her life that brought her joy, so that day wasn’t to be her end. I got four more years with my baby, she just passed 7/9/16 in our bed.

Trust yourself and your instincts, don’t hesitate to keep seeking the advice of several veterinarians.

[jerseygirl]

Posted By jakeadair2 on 11/28/2016 9:43 AM

I want to ask as another question, as I haven’t been able to find a good answer: with EC is there a time when it is “too late?” Like the parasite has infected his brain too much and even if we get the proper treatment too him he will not regain functionality? In that sense I guess is it different to be weak/unable to move because of a parasite in your brain as opposed to dizzy from an infection in your ear which can clear up?

This is something i had a bit of a mini “revelation” about when Maple was going through treatment. Something the vet said made me realise… Im sorry in advance if Im sounding vague! It’s me “thinking out loud”, trying to recall. 

 Basically, I realised that lesions heal and that is why we would sometimes turn-arounds in this condition.   It’s also why anti-inflammatory meds and antibiotics are important if there are lesions, because where there is inflammation, there is opportunistic bacteria ready to move in and cause further infection. I never did look into it further as I was so occupied at the time with her care. I think there is possibly some scarring left in some cases which would leave a rabbit some with permanent ailments. 

I’ll try look into if there is some info that covers this…

When I took my friends rabbit to the vet when he had his relapse, this vet was very honest. He said what they do today, they really don’t have concrete evidence if it’s the treatment that helps or if it’s a case of the rabbit got better on it’s own, despite being treated. They just have to ask themselves, “is treatment doing harm?” If no, then proceed. He also said it’s one of those things where the approach for treating it changes. It’s different now from what it was years ago. And in the future, the current way it’s treated could be scraped. Hope Im making sense!

Regarding Quality of Life, perhaps this article will help navigate that? http://rabbit.org/quality-of-life/

[vanessa]

Warning – sensitive post.

So many things to think about…
I hate reading stories where a case of potential EC is not treated as such, is treated for too short a period, or is treated with “not the best choice”. I’m not familiar with the doseage and time period for using oxybendazole for EC, because it is not the preferred bendizole. Fenbebdazle is the drug of choice. So while it is a good point that you would want a vet’s opinion on switching, fenbendazole definitely has a better track record.
How late iw too late? Well, firstly, it gets worse before it gets better. After one week, I was calling my vet in panic. Lancelot went from limping, to paralyzed. From eating his greens, to not eating or drinkign anything at all. The vet told me to stick it out and wait for the meds to do their work. After the 28 day treatment, he started to make huge improvements. So I woudl always recommending staying the course of treatment, before makign a desicion. As far as how late is too late to reverse damage, there isn’t a medical answer for this. In all the case studies I read, I’d say half recovered completely, and half didn’t. Lancelot is in the half that didn’t. He still has no bladder control, his rear legs are still weak, he doesn’t use the second level of his condo anymore, his eyesight is worse (he can see light/dark, and shadows), But emotionaly, he is full of spunk. He is his same old enthusiastic self. And I still see small improvements – no urine scald on his feet for the past week because he is more mobile, so he doens’t sit in his pee anymore.
The weak legs are from nerve damage from E.C. It damages nerve cells by the action of granulomas, or the body’s creation of scar tissue in response to the initial nerve damace (bursting of cells). Some nerve damage can heal, some can’t. We just don’t know for sure what a bunny’s prognosis will be. Some rabbits recover, and some simply don’t. And some, like Lancleot, get recurring bouts.
When I had Merlin euthenized, I didn’t recognize the symptoms untill he was paralyzed, and warbles in his skin from the urine scald (horrible disgusting fly larvae). I hadn’t figured out how to keep him dry and clean, and I didnt’ believe that I would be able to care for him. So after that learning curve – I recognized Lancelot’s symptoms quicker. Wen I felt my regular vet wasn’t being proactive enough, I took him for a second opinion and second round of treatment to a more hands-on vet. I still use both vets. The first when I know what I want, the second when I want a more indepth treatment.
The first vet actually wasn’t even going to prescribe fenbendazole for Lancelot – he didn’t want to “pigeon hole” it as E.C. I feel that the benefits of treating it with fenbendazole and antibiotic outweigh the risks of only treating with antibiotic, when the symptoms could be from EC or a bacterial infection. There is a documented risk of fenbendazole causing red blood cell failure, but only in long term use. the 28 day treatment has not shown red cell failure.
Since I euthenized one bunny, I was personally going to do everything I coudl to help Lancelot pull through. That was my desicion rational. It is different for everyone. A disabled bunny requires a lot of care, time, and emotional investment. And money.

I agree with the desicion of – is the rabbit still enjoying life. But with E.C., it gets worse before it gets better – so you dont’ want to give up before the rabbit has had a chance to get over the worst of it. Maybe I gave up on Merlin too soon. I don’t know. It definitley shaped my attitude about E.C.

[vanessa]

Got to be honest too… I didn’t ask a vet for ivermectin. I got the dose from medirabbit, read some case studies where it benefitted the E.C. treatment, and since many medicines are available online without a prescription for birds – I happen to have ivermectin. I always keep a supply because it is used in mite treatment/prevention. It is also available at your local feed store, for horses, where it is sold in a much larger dose.I worked out the mg/ml for what I have, and got it to how many ml I need to give Lancelot for his body weight. If I bought it at a feedstore (probably cheaper), then I would have to compound it down, which would require quite a sensitive scale. It always involves slow painstaking math. Playing vet at home isn’t recommended, I just did it because I read enough case studies to feel confident, and I was desperate to pull Lancelot through. I’m also trying gamma linolenic acid, an extract from borrage oil. My bunnies loooove borrage leaves, and who knew the seeds had such a potent oil. I read a research case where a set of rabits had their cornea burned with an alkalike substance, and they were fed this supplement. The GLA bunnies healde better than the non-GLA bunnies. So… I’m giving it a try. I’m going off the deep end here – not tryign to encourage anyone to self-medicate their bunnies. But – this is how I treated Lancelot. And I woudln’t have done it any other way. He has pulled through so well. You also can’t underestimate the value of emotional and physical support to the sick bunny, but it has to be paired with good medical treatment. Through my experience withMerlin and Lancelot, my opinion is – always treat EC early and aggressively. If you read the book “When you r rabbitneeds special care”, you’ll also read many stories of disabled bunnies living happy lives. The book also describes cases where the bunnies lived untill they showed no interest in living, in which case they were euthenized. But with EC it is really important tosee the treatment through, because of the wore-before-better recovery style. OK – that’s it for my soap box… I’m sorry this is so difficult for you. Please keep usposted. Many vibes.

[jerseygirl]

Vanessa, it’s really interesting that you saw the majority of improvement happen after the 28 day treatment. It was from others posting about this that reassured me to see out the month when I was treating Maple and then watch from then on. Good to know of a recent case where this proved to be true.

[jakeadair2]

Thank you guys for your posts, it is good to hear from people no matter the outcome. Buster was still alive this morning, he is at a point where he can “move” in the sense that he is not paralyzed, but cannot stand and will more or less remain where we put him. I gave him two feedings before work this morning of lettuce, hay with a little pumpkin, and water. My wife will give him food throughout the day. We have done 18 days of oxibendazole, which is a 28 day dose same as fenbendazole. I have ordered fenbendazole as well but don’t know if it is better to see out the full treatment with oxi. From what I read they both work, and oxi may be less risky and may reach deep in the brain better.

We have done 8 days of baytril, and my wife is going to go and get another antibiotic today. We don’t know what is the best option, though I see chloramphenicol mentioned? Is there another antibiotic we should consider, and should we go for a strong dose? My vet is most concerned with his appetite and gut health, and thinks we should stick with baytril longer, but he seems to get worse every day and we have thought the last two nights that he would die overnight. Should we do two antibiotics? Stick with baytril and up the dose? Stick with baytril at the current dose (which is like 5mg/kg)? Or switch to another drug. We are worried that we used the baytril for 3 weeks in october but the infection is back and may have become resistant to baytril.

Any tips for us today are greatly appreciated.

Thanks for everyone’s help and general support as well.

[vanessa]

It’s true that the oxi reaches deeper in the brain, and is less risky. At first I was paranoid about using fenbendazole because of the risk of blood cell failure, but after reading that the risk has only been proven with long term therapy, I relaxed. Lancelot had 2 months between each 28 day treatment. If I were you, since you are on day 18 of oxi, I woudl finish the course, wait 2 months, and try fenbendazole, depending on how your bunny is doing then. I’m concerned that after 18 days, the infection is back. I would be more inclined to change the antibiotic.
All medicine hs someor other nasty side effect, or bad potential. It if didn’t, it wouldn’t have any medicinal effect. So yes, we do naturally prefer to choose the less risky meds. While you are doing yoru research, balance the risk against the benefits. For example, I chose to use aspirin over metacam, because the metacam caused Lancelot to completely stop eating. It has the potential to swuash appetite. Not always, but it’s been noted. Aspirin is contraversial because it reduces fluid throughput in the kidneys, and can cause stomach ulcers. I knew Lancelot’s kidney’s had tested fine, so I took the risk and gave him aspirin. It helped. I wouldn’t go for a strong dose. I woudl go for the doses recommended in medirabbit. My vet uses the same doses as medirabbit too.
On occasion, a vet will recommend two antibiotics. I haven’t researched this much myself. I have personaly used SMZ, baytril, and Chloramphenicol. I do seem to recall in one case being prescribed SMZ and Chloramphenicol at the same time. Another drug that has been used off-label with success, is Ponzuril, in combination with fenbendazole. (I imagine it would work with oxi as well). It is a protozoal type of drug.
My friends, my boyfriend, and I, all were worried about Lancelot dying too. It’s so hard, but I think you should probably finish out the oxibendazole, talk to yoru vet about chloramphenicol and ponzuril, and wait untill 28 days have passed to evaluate his recovery. His appetite and gut health can be nursed by using critical care. I syringe fed Lancelot for weeks. All his for and water. Critical care has hay, for his gut. I would also add the reccomended dose on the package, of benebac, to help his cecum. You can nurse his gut that way, but I would focus lyzed”on the infection. As long as he is feeling ill, he won’t want to eat. So focusing on getting him to eat – would mean – getting the ear infection under control. I’m not minimizing the gut. It is just easier to nurse that, than an ear infection. It sounds like he is feeling terribly dizzy and nausious. I would hold Lancelot on my lap for hours. He would lie with his head on my arm, licking my wrist. He was “paralyzed” for weeks. I documented his recovery on my threat called “Lancelot has bladder/arthritis issues” if you want to peruse.

[jakeadair2]

Just to let everyone know, Buster passed away last night. We thought we started to see some improvement (moving his legs on his own, though he couldn’t stand, and reaching for and finding food on his own). However, after a syringe feeding and before bed he began to seize and foam at the nose and mouth and passed away. We both held him as he went and he was with Binky as well, and we let her have a few minutes with his body afterwards. She took note, but seemed ok and continued to eat the greens with him in there. This morning she seems ok, if a little agitated. 

Thank you to everyone for your thoughts and help, hopefully the thread can be helpful to others who go through similar situations.

[jerseygirl]

Oh I am saddened to read this. I’m so very sorry. It is obvious you and your wife cared very much for him.
Sleep tight, little Buster.
I hope Binky will do okay with him gone. She is lucky she has you both to help her adjust and keep her company.

[sarahthegemini]

Oh my goodness, I’m so sorry to hesr such sad news I hope Binky manages to move on from this but do let her grieve. My thoughts are with all of you, it sounded as though you were doing absolutely everything you could do though so at least Buster knew he was well loved and cared for.

[vanessa]

I’m sorry. My little guy Merlin also had a seizure. It was a week before I had him euthenized. I’m sorry this was so painful for you. You did everythign you could and Buster knows it. I believe that animals recognize when we are trying to help them. I’m sorry for Binky. It was good that she got to spend time with his body. I’ve heard that it helps the surviving bunny.

[Bam]

I’m very sorry. You did all you could, EC is a really sneaky parasite. I hope Binky will cope. Spend extra time with her if you can.

Binky free, sweet Buster.

[Author]

Messages