Head tilt.. Not responding to meds

Question
QUESTION: My bunny has had balance issues (including occasionally falling over unable to get up) and a weepy eye for over 7 weeks now. The vet could see torticollis but no sign of any ear pus or anything to culture.

We did a month of panacur and at the same time put her on 48 hour bicillin injections (0.25ml). Then two weeks ago added in 1ml baytril twice a day (she is 1.2kg). She is already on 0.4ml metacam twice a day for her arthritis, and she turns 12 next month. Also twice daily eye drops,  ocuflox for 6 weeks month then 2 weeks now of Torbex. The eye weep went away about a week ago finally.. Touch wood it won't come back.. It did before halfway through the ocuflox after a week of going away.

So it's been 7 weeks now of bicllin and 2 weeks of baytril, but since last week her dizziness and falling over is getting worse and her head tilt is more pronounced. She seems less able to get up as well now.. Before she would only get stuck once every few weeks, now it's every day....At this point the vet is at a loss. He checked her teeth and they look good, she is eating well and no signs of pain.

Any ideas what to do now?

Gwen

ANSWER: Dear Gwen,

I would ask the vet about treating for E. cuniculi.  We have used Panacur (fenbendazole; 20mg/kg Q24 hours) and ponazuril (20mg/kg Q24 hours) together with good results.

The weepy eye could be due to dental problems that can also affect the inner ear and balance:

http://www.bio.miami.edu/hare/weepy.pdf

Please also see:

http://www.rabbit.org/health/tilt.html

and

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


I hope this helps.

Dana

---------- FOLLOW-UP ----------

QUESTION: Thanks for the response - however we did treat for a month with the panacur as I mentioned above... was that not long enough?

Answer
Dear Gwen,

I would try ponazuril in addition to Panacur (fenbendazole).  Sometimes the two drugs working together are far more effective than either one alone.

Note, however, that a head tilt will not always resolve on its own.  Please read the article I sent before:

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

If the muscles of the chest and neck have become fibrotic, then you may need to do extensive massage and physical therapy to get her head back into a normal position.  The article has more details, as well as a link to a physical therapy regiment developed by a human physical therapist for his rabbit.  It appears to have worked well!

The parasites or infection might be gone, but the head tilt could be a mechanical problem that needs an entirely different approach to improve.  It may never completely resolve, but a bunny can live a totally happy life with a head tilt (and look pretty adorable with it, once you realize it doesn't bother him).

Hope this helps.

Dana