Boo-Boo

Question
Dana,

I have been working with my vet on a problem rabbit for the past 2-3 weeks.  I contacted AllExperts and got good advice that for the most part was right on.  My contact is now on vacation so I have contacted you in hopes of saving this animal.

Boo-Boo contracted ileus about 2 weeks ago,  I was informed that this usually is secondary to something else.  I live on Guam so rabbits vets are few and far between.

My vet started to treat the ileus and Boo-Boo was responding.  3 days ago she crashed.  She developed head tilt and is now in bad shape.  My vet has her sedated and is pouring the antibiotics to her with steroids.  He figures we will deal with the ileus later.

My concern is that as of this writing Boo-Boo has been on antibiotics for 2 days but there is no change, no better but no worse.  My vet seemed to think we should have seen improvement by now but it has been only 2 full days.  He is a bit frustrated and disappointed.  I suspect an ear infection.  He also trimmed her teeth to be sure we thought of everything.  He did mention that her teeth were very mis aligned.  He can not find any other indications of other ailments and he has been aggressive.

I want to give a little more time, here is my question and comment.

If the head tilt was due to an ear infection which my vet said did exist as he needed to clean her ears of crust.    (he is not convinced it is an inner ear infection but does not rule it out either)  How long should we wait to see improvement.  We are starting to talk about alternatives but I don't want to move to fast.  He knows how important this rabbit is to me and will give me more time but??????

Is there anything else we should be doing?  Is it possible it is something else other than an ear infection we can treat?

Mike  

Answer
Dear Michael,

Head tilt can have several different causes, but if your vet did find crust and pus in the ear, then an ear infection is a likely culprit.  Did the vet send a sample of the pus to a lab for culture and sensitivity testing?  I would recommend this, if possible, so you'll know that the antibiotics you're using will be effective:

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

Even when the right antibiotics are being used, it can take time for the tilt to start to improve.  Depending on the antibiotic, it can take from three to five doses before a therapeutic level is reached in the bloodstream that can really start to kill bacteria.  Add to this the difficulty for most antibiotics to penetrate an abscess (which could be nested in the middle or inner ear), and it could take a week or more before you start to see results.  

In the meantime, supportive care is essential.  If bun can't eat by himself, he'll need force feeding with pellet mush.  If he can't drink, he'll need subcutaneous Lactated Ringer Solution and/or careful oral water via dropper.

I don't agree with the vet that the ileus can be left for later.  Believe it or not, it is even more of a life threatening problem than the ear infection (the pain of which may well have been eliciting the ileus even before you saw the head tilt).  Please read:

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

and provide this for your vet:

www.bio.miami.edu/hare/ileus.pdf

if you haven't already done so.  It has important instructions not only for medications that must be used to reverse the ileus, but also for treatments you can do at home that may be even more effective than the drugs (e.g., gentle, abominal massage).  Don't forget the pediatric simethicone suspension for gas and analgesics.  Pain relief can make all the difference in the world to this bunny's willingness to fight the illness.

Now, on to the tilt itself.  Please read these two articles:

www.rabbit.org/health/tilt.html

This one, written by an expert rabbit vet, is long but *excellent* and a great resource for your vet if s/he is amenable to receiving information from strangers on the internet.  It covers about every possible cause of head tilt, though I think it doesn't emphasize the possible contribution of E. cuniculi very strongly (mainly because not everyone is convinced that E. cuniculi can cause head tilt), but this should certainly be considered, in my opinion.  Panacur (fenbendazole) or oxibendazole have been effective in many cases, and a newer drug, Ponazuril, may be even better.

Please also see:

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

The latter will help you with instructions and therapies that will help you make your bunny more comfortable and suggest ways to speed recovery with physical therapy and exercise.

The instructions for making a pellet mush are included in the ileus.html article above, but if you can get Critical Care from Oxbow, that would be ideal:  www.oxbowhay.com

They do ship internationally, so it might be worth a call.

I hope this helps get you started on the road to your bunny's recovery. Please don't hesitate to write if you have more questions.  There's a possibility I'm going to put my self on vacation shortly, but if you write to dana@miami.edu I will still get the email unless it's sent between March 6-11, when I'll be out of town and not have access to my computer.

Sending lots of healing vibes...

Dana