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Rabbit keeps losing balance

22 9:52:38

Question
Dear Dana,

I have a 4-year old albino lop-eared rabbit named Lily ( she weighs a bit more than 4lbs), last Wednesday she started to seem a bit off, she wasn't eating as much, and wasn't as friendly as usual, by Thursday she stopped eating and drinking and was very lethargic, when I was getting ready to bring her to the vet on Friday, I noticed that she was off-balance, and she fell over. The vet did some type of xray (she called a radiograph I think) and it showed a lot of stuff in her intestines. The vet said it was most likely a hairball, and that we would have to force feed her (this happened to her before in 2009, and the force feeding solved the problem), but the vet said she was concerned about the loss of balance, because it could be several different things, she said it could be pasteurella virus, or an inner ear infection but she said that it wasn't the traditional presentation of a head tilt so she kept her overnight to observe her.

The next day when we went back to the vet, she told us that Lily was moving her head back and forth from side to side (as if she was looking around the room) and that it concerned her because it might mean it was neurological, but she told us we could take Lily home that night, and the vet gave us a bunch of different things to give her. We're giving her Metacam, Vitalax, Cisapride, Enrofloxacin, Fenbendazole and Lactulose. My vet said that it could take anywhere from 1-4 weeks for her to show improvement if it was in fact an infection (the force-feeding seems to be working, she is eating more and pooping almost normally), she also recommended that we take Lily to get a CT scan to rule out any neurological issues.  

What concerns me is that she doesn't seem to be getting any better with her balance, she has fallen 3 times in the last hour, she doesn't seem too bothered by it, she gets back up and seems to be fine afterward. I've noticed that she falls mostly on her left side, and that she can't clean her right ear, she loses her balance every time she tries.

I would just like to know, based on what I've described, if you think it sounds like an infection, or if it seems more neurological, because my vet strongly recommends a CT, but the other question I have about that is: Is it worth the risk of putting her under anesthesia for the CT scan, because I know there is a high risk of rabbits not waking up from the anesthesia, and if we were to find something on the CT would it even be treatable?

Thank you for your time,

Jane

Answer
Dear Jane,

The rule of thumb for any risky procedure is:  If it won't change the treatment protocol, then don't do it.

I'm not sure a CT scan would be very helpful here, unless she had a brain tumor or very obvious intracranial abscess.  Both of these are very rare, and if you treat for the other (much more common) causes of this type of presentation, you can rule out the tumor or abscess.

I'm not sure what the vet means by "typical" head tilt.  But the signs you describe are certainly consistent with an inner and/or middle ear infection.  Our vets often use injectable dual-acting Penicillin G Benzathine/Procaine for these types of infections, as they it has good penetration to the inner ear and good coverage of the most common pathogens causing such infections.  Please see:

www.rabbit.org/health/tilt.html

for an excellent overview, even if your bunny doesn't have the tilt.  Not all rabbits with ear infections get torticollis, and even E. cuniculi can present this way.  Our vets are now using Panacur together with ponazuril (toltrazuril sulfate) to treat this.

And yes, it can take weeks to see improvement.  But it will take longer if the right medications are not being given.  I hope all goes well, and that your bunny will improve soon!  Please ask about the Pen-G.  It can be very effective in cases like this.

Dana