Vet suggested high Metacam dose, am worried hes now getting too much!

Question
QUESTION: One of our bunnies, Frederick is about 7 (guessing).  He has had back leg problems over the last couple months off and on.  About 2 wks. ago, he was pretty much dragging them but was very game to come out of his pen.  I took him to the vet and this one told me physio to do and said he had no dislocation in his hip.

He was getting better, using his back legs more and even stretching up on them at times for almost 2 wks. then almost a wk. ago, he was dragging them again.  I took him to the same clinic but saw a diff. vet.  She took 2 x-rays, showed them to me and explained no dislocation, no fractures or couldn't see signs of spondylosis either.  Her best assumption was a disk which wouldn't show on an x-ray is pinching a nerve or his spinal column.

She suggested rest for him in his pen mostly (no crawling around all over the floor) and give him a calculated high dose of Metacam for his back twice per day.  He is 6.8 lbs. and his dose is 1 cc twice per day and it's the concentration that you're familiar with (I can't remember right now).  She did mention that if I saw him improving, I can lower the dose.  Already the next day he is sitting on his haunches more and seems contented.

Is this dose too high?  She's not an exclusive rabbit vet but doesn't seem to be scratching her head and looks things up too while I was there for extra information.  

Thank you if you could please get back to me,
Paula

ANSWER: Dear Paula,

Has the vet even considered the likelihood of E. cuniculi?  Please read:

www.bio.miami.edu/hare/paresis.html

and direct your vet to this article by rabbit expert, Dr. Susan Brown:

http://www.veterinarypartner.com/Content.plx?P=A&A=490&S=5

While spondylosis is possible, E. cuniculi is quite common, and I would ask the vet about starting Frederick on Panacur (fenbendazole; NOT albendazole!) and/or ponazuril, so the problem at least does not become worse.  Metacam will help with the inflammation associated with the parasite, but will not be a cure, nor will it arrest progression of signs.

The metacam dosage given is quite high, which could be a concern if this is E. cuniculi since both the parasite and the drug can cause renal insult and damage.

I hope this helps.

Dana

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

QUESTION: Thank you for your answer.  I've forwarded your letter & link to my vet clinic's office (email).  I will have to wait until Monday to see if she got the letter (& article) & read it.  If she decides she doesn't want to continue care & sends me to my other vet further away (& checkup money again), can I legally get the X-Rays to take to the other vet so I don't have to pay again?  We live in Ontario, Canada but I'm hoping the law is the same here as the US?

Also, when I mentioned Panacur a few days ago, she claimed it was toxic and would not dispense it until Frederick had a blood test.  Wouldn't all rabbits test positive for this parasite anyway?  

If I get Panacur, what would the dose be for a 6.8 lb. bunny?  Also, would I still be able to give him Metacam for any back pain and how much?

How much time do I have to get Panacur into him in case I have to change vets and start over?  He's had this off & on with his back legs for almost 2 months (guessing) & worse over last 2-3 weeks.

Since he's been on Metacam (high dose she gave), he's been sitting up on his haunches more and still eating.  I lowered his dose by about 1/2 yesterday (2x day) to .65 2x and he didn't want to eat in evening.  I gave in and added .35cc of Metacam and he ate later in evening and was moving more.  Whether that was a co-incidence or not.

Thank you so much.  I know I've asked a lot of questions in my follow-up but I hope you can answer them all.

Take care,
Paula

Answer
Dear Paula,

I don't know what the laws are about ownership of radiographs in Canada, but it can't hurt to ask the vet to share them with any other vets you decide to see.

While it's true that Panacur (fenbendazole) is a radiomimetic drug (i.e., it can mimic the effects of short-wave radiation, and can have adverse effects on the bone marrow, and possibly other tissues), it is one of the more benign members in this class of drugs.  I would not give albendazole to a rabbit, as it has been associated with acute death in rabbits.  But our rabbit expert vets have used Panacur on thousands of rabbits with few or no side effects.

And no, not all rabbits will have a positive titer for E. cuniculi.  

Our own vets use both Panacur and ponazuril to treat E. cuniculi, and this has given us excellent results.  The dose our vets use for both drugs is 20mg/kg once per day for 30 days.  

The metacam is likely to help with his mobility, even if this is due to E. cuniculi, since it's believed that one reason for problems with paresis and torticollis associated with E. cuniculi is inflammation due to the parasitic cysts.  No one is sure, but if the metacam is helping, that's good.  Our vets prescribe a dose of 0.1-0.3mg/kg once per day, but others use it more frequently.  A lot depends on the individual patient (not to mention the vet) and other health factors (such as kidney condition).

Hope this helps.

Dana