URGENT please Dana wrt E.c, bloods and treatment

Question
QUESTION: Hi Dana,
Firstly, thankyou, thankyou and lots of hugs for the time you take helping people like me with their rabbits' health needs. You're an angel and we're so lucky to have you. You have helped me out of fixes more times than enough reading your answers on allexperts.com and on HRS. Now I have one more:
My 5yr old female dwarf lop, Kayla, was diagnosed with renal failure recently and I was told she will die within a couple of months. She has lost about 20% body weight and has nasty urine scald that I have started applying Calendula Ointment to (will look for baby cornstarch). Is this appropriate for the scald? The vet says she has no tooth problems, abscesses or any other Pasteurellosis related health issues (although P.multocida has wreaked havoc with my rabbits in the past and I've used your advice here with regard to the subcut "bicillin" and sometimes Enrofloxacin)
Her son, Hopsy, who is 4, has developed head tilt which has improved a bit with the enro/bicillin and also has no obvious other health concerns besides 10% BW loss. His nystagmus cleared with the above treatment but his eyes aren't quite right. We are giving Critical Care by syringe as he isn't eating much besides greens.
Her daughter Snowy snores and otherwise is healthy (this has gone on since late last year).
An unrelated upright eared 3kg almost 3yr old black rabbit, Mica, got a film over his eye a couple of months ago which worsened to the point where it had to be removed as it was inflamed and painful for him. He's responded well. I have noticed the urine output in the litter boxes in his enclosure(shares with 2 sisters) has increased and I wondered about more kidney problems. We thought his eye had been scratched in a spat with another rabbit but now I'm wondering.
Just last night, I noticed his sister has lost 17% body weight but otherwise looks fine- no soiling at vent, no abcesses, nothing else and teeth fine.
These rabbits are fed ample fresh greens (around 3 cups per day each or more of variety), unlimited hay (grass hay and when unavailable lucerne but I try to minimise this because of calcium/calories). Only the two Netherland Dwarfs get pellets (about 1/4 cup each/day) but I only cut these out with the others because I was worried about Kayla's kidneys and weight problems. They live indoors, have plenty of range and are well loved.
This is sounding more and more like E.cuniculi to me (had never heard of this before). What do you think? I read your 20mg/kg Fenbendazole and 50mg/kg Toltrazuril for 30 days regime and would like to try it. I have 10 rabbits, all spayed/neutered and don't know whether to treat the healthy ones and whether both drugs for the whole 30 days or even if I'm on the right track here. The vet isn't able to help much further  (although has been/is always receptive to yours and other rabbit experts ideas/advice) and I do not have access here in rural Australia to your wonderful rabbit savvy vets.
These rabbits are almost my entire world. I'm desperate to stop this cascade of problems as it is already out of hand. The remaining "healthy" black rabbit, PK, was hand-reared from birth thanks to our wonderful Wombaroo Rabbit Milk Replacer and she is everything to me, as are they all. Most were rescues one way or the other.
Please, please help, Dana, I'm heartsick over this, just desolate. I will be beside myself waiting for your answer and thankyou so much in advance.
Take care,
Nerida

ANSWER: Dear Nerida,

Renal problems and neurological problems (e.g. head tilt) have both been linked to E. cuniculi infection, and your suspicions are not unreasonable.  And if one rabbit has it, it's not at all unlikely that they all do, since this parasite is believed to be transmitted via the urine of infected rabbits.  

I think many of our rabbit-savvy vets would agree that it wouldn't be a bad idea to give *everyone* the 30-day course of Panacur/ponazuril.  We have done this for incoming fosters with unknown history and have seen no adverse side effects.  One, Tilda, who had a *severe* head tilt with no evidence of ear infection showed fantastic improvement over her course, and though she has a slight residual tilt, she has had no further problems a year later.

Without being there to see the bunnies, I certainly can't know if this is the only thing going on.  But I agree it would be worth trying the Panacur/ponazuril.  

Just a note:  if you have another bunny with a corneal ulcer as Mica did, please write to me for help with treatment.  Our fantastic veterinary ophthalmologist, Dr. Karpinski, has worked miracles with eyes that were so damaged they looked like miniature caulifowers.  An eye this bad *can* be saved with proper treatment, and only minimal scarring has been left on even our most severe cases.

Hope this helps.

Dana

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

QUESTION: Hi Dana,
Thankyou for your reply and note about the corneal ulcers. Mica is happy as anything, back to normal, he is almost dangerous with two eyes- he gives Kayla's brother, Patch, a terrible time on the dominance front. The tables turned there while he was distressed.
A question about Kayla, if I may. Her weight loss is accelerating, her spine is prominent and it's getting critical. How long till we see results with the treatment if the are to be any? She's had three days of 20mg/kg fenbendazole and 50mg/kg toltrazuril. We have started syringe feeding her which I haven't done before because worried about her kidneys and the protein factor with Critical Care. Should I continue with this or will this knock her kidneys about too much? I feel if I don't, we'll lose her anyway. She is a little quieter the last couple of days, too, almost subdued.
I'll answer the other one here, too, if that's alright. A drench is what farmers call the over the tongue or oral bulk form of dosing livestock. I hope this is okay to give her, it's used for sheep and cattle and goats and such so this is very much extra-label. If you can qualify that this is ok, I'd be grateful.
Thankyou again. Take care,
Nerida

ANSWER: Dear Nerida,

In a case like this, your choices are (1) feed her and risk protein challenge to her compromised kidneys or (2) let her starve to death.

These are not good options, but I certainly would prefer #1.  It will prolong her life, even if her kidneys have to work a bit.  This is what they're for.  And although they are failing her, withholding critical food because it will make her kidneys work is not the right choice here.

She may not have long to be with you.  If she is in renal failure, all you can do is keep her comfortable and fed.  Be sure she is well-hydrated, too.  This will help flush toxins from her system.

Have you noticed that she's having difficulty eating?  I always wonder in a case like this whether severe molar spurs or other dental problems are the real cause for weight loss, and not the kidneys.  But if she is well hydrated and her B.U.N. and creatinine are still high, then it's not good.  

The toltrazuril will not reverse renal damage, though it might prevent further damage.  The question is:  how long can she survive with her kidneys as damaged as they are?  The only way to know is to support her with food, fluids, pain meds as prescribed by the vet, and love...and hope for the best.

Dana

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

QUESTION: Hi Dana,
Thankyou again for all your help. Hopsy was put to sleep Wednesday night, I do not feel at peace with this but he was falling and rolling all over the cage and the vet felt he would injure himself, causing him more stress and pain. She is the most compassionate and helpful vet I've ever known and would not have recommended this lightly but I wish we'd worked out a way to pad up a crate for him and persist for a time longer. He was still trying to grab food and eat before he lost balance but we were maintaining his weight (just) with syringe feeding. I can't undo it now. Kayla gave up outright with him gone and, although she had been given a few more days, was refusing to swallow anything despite all kinds of persuasion. She was literally starving to death and had to be put to sleep yesterday morning. So this is a miserable time for us all as Patch, Snowy and Nikko are losing more weight.
Our vet seemed to think the treatment may take 9 days to take effect- is this your experience? If not, what is? I have investigated serology for Mica for E.c as he is not on treatment but think perhaps your labwork on it may be far more sophisticated than ours. Apparently, there are false positives (and perhaps negatives) with it here and results may not be conclusive or helpful. I really need to know if you think I should get it done or just get him and the rest on the treatment ASAP (this is my feeling, panicked as I am, it is Saturday here, the blood will only get to the lab for Thursday and, to me that is just too long). At this point in time, have there been any established or seriously linked adverse effects to possibly healthy rabbits being treated with fenbendazole/toltrazuril combination? To me, the benefits way outway the risks but I would like to know as, at the moment I'm so down about the whole thing that I can barely think straight. If you have time to answer this ASAP, I'd be forever grateful as the vet can't find another thing wrong with them and I don't think it's our old enemy Pasteurella causing this trouble.
Thankyou again for all your help.
Kind regards and take care,
Nerida

Answer
Dear Nerida,

I am so very sorry about the tragic deaths of your friends.  How very sad.  But it really sounds as if Hopsy was not going to recover from this, if so much neurological damage had been done.  

If you can find it in your heart to have a necropsy done, including histopathology of all major organs, I would have this done on both Hopsy and Kayla.  This might well save the lives of your other rabbits.

But for now, if these were my rabbits, I would begin the Panacur and toltrazuril without delay.  Also ask about NSAIDs (e.g., metacam) to help with any inflammation that could be contributing to their problems, if the vet thinks it would be safe for their kidneys.

I hope the others will be fine, and I am very sorry for your loss.

Sincerely,

Dana