Wheezing and weakness

Question
QUESTION: Hi Dana

My bunny is recently suffering from wheezing/sneezing.  Unfortunately it co-incided with a necessary dental, although antibiotics had helped the wheezing before he had the aneasthetic.  His teeth appear fine now and he is eating.

We originally thought the wheezing was the result of a new bale of hay we got, due to timing, and that this was really the only change to his environment, other than the fact we know they are harvesting in our area - we live in the country.  He is outdoors with his companion during the day and indoor in the evening and overnight.

After the wheezing started, we withdrew the hay and he was given antibiotics.  After a week he seemed to improve.  We then introduced a different type of dust free hay, and he seemed fine with this, but after a week the wheezing/sneezing came back - he's on more antibiotics now.  

We're unsure whether the chestiness that the vet hears came back due to the withdrawal of antibiotics, or the introduction of the new hay, or neither.

Another odd thing is that he is normally a spritely, bouncy boy, but since the day of the aneasthetic his hind legs have appeared weaker, and we though this would pass, but it's two weeks after, and not went away - still seems a bit weak.

He is eating fine, but is not as interested in pellets as he used to be.  His teeth have been checked though, and are fine.  He is currently on baytril, and injectable antibiotic, and metacam.

He is being given Timothy Hay, but doesn't bother with it - we washed some of the bale of hay we have and have been hand feeding this to him, as we don't want him to stop eating hay, but also don't want to make the wheezing worse.  Just not sure about the hind leg weakness - could this be connected to the wheezing.  We're currently keeping him indoors with the windows closed - to see if it's the harvesting outdoors that's bothering him, but that's only been since yesterday, so not sure of effect yet, and won't even be sure if the effect could be the injectable antibiotic from the vet either.

Do you have any opinions - we're back at the vet tomorrow for another injection.  I've heard ec can cause hind leg weakness - he is one and a half years old - as a routine we gave him panacur when we adopted him, and he's had another routine course of it within the last six months.  We are aware that his companion has been subjected to the exposure of ec, as her previous companion boy was ec positive, although never displayed symptoms.

Any thoughts you have will be helpful.

Lynn

ANSWER: Dear Lynn,

Please ask the vet about doing some chest radiographs (without anesthesia, if possible, since if he has a lung infection this would be risky) to see if your bunny may have pneumonia.  If he does, you might want to ask your vet about adding nebulization to a long-term antibiotic therapy.  We have found that nebulizing with an amikacin-based saline (including aminophylline to open the airways and Mucomyst (acetylcysteine) to loosen gunk in the lungs) is very effective, if done twice a day and coupled with marbofloxacin (brand name Zeniquin) for most of the bacteria we have cultured in bunnies (and hares) with pneumonia.

The hind limb weakness may or may not have anything directly to do with the lung ailment.  An immunocompromised bunny who is also carrying Encephalitozoon cuniculi is more likely to show signs than a bunny who is otherwise healthy.  So please also ask your vet about that.  You can read more here:

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

It also might be that he's simply not getting enough oxygen, and is showing weakness in his hind end partly because of that.

Whatever antibiotics are prescribed, be sure to use the whole course and don't miss a dose.  In every case of pneumonia we have successfully treated (and there have been many), we have kept the rabbit/hare on continuous treatment, including nebulization, for *at least* three weeks, even if symptoms subside. We've found that doing otherwise invites more resistant bacteria to return once treatment has stopped, so we hit them HARD and LONG to be sure of the best possible result.

I hope this helps!

Dana

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

QUESTION: Hi Dana - we are stil having problems with Charlie.  We had already had chest xrays taken at the time of writing, and they weren't as clear as the vet would have liked, so that was why he was on antibiotics.  Fortunately the wheeziness and chestiness seems to have cleared up, but he's still on engimycyn (injectable antibiotic)

However, his hind legs have become weaker, and he literally drags them behind him when trying to move - we are wondering if it could be nerve damage, as a result of the aneasthetic when he had the dental, as it was that evening that he became weak on them.

He is also losing weight, but eating quite well, so this is worrying.  A blood test showed he is very aneamic, and his white cell count indicates he is fighting something, but they are not sure what.  No probs with liver/kidneys, and no obvious problem on xray of legs, spine and hips.  The vet thinks it might possibly be collection of micro-abcesses too small to pick up on xray.  If not, they think inflammation of some kind.

His ec test came back positive.  But the level indicates exposure to ec, rather than active infection.  He has just finished a course of panacur, and is currently on zantac and metecam in case of inflammation.

Your thoughts would be helpful as we are worried about the general weakness/weight/muscle loss.  We are also considering alternative therapy i.e acupuncture/reiki as an 'extra' and wondered about your thoughts on such.

Lynn

Answer
Dear Lynn,

It sounds as if Charlie's immune system isn't really working very well.  :(  And if this is really the case--and if he's fighting several pathogens at once--he might well show a relatively low titer for E. cuniculi.  But that doesn't mean he doesn't have an active infection.  It could mean only that he's not mounting a strong immune response to the parasite, possibly because he's fighting something else in his lungs and his immune system is being swamped.

When you say he finished a course of Panacur, how long was that?  Most vets treat for at least 28 days.  Another drug to try would be ponazuril, which was developed for horses with a similar parasite, but has shown promise in rabbits.

If his lungs are not clear, then please ask the vet about nebulizing him.  We've found that most lung pathogens in our rabbits have responded very well to oral marbofloxacin coupled with injectible amikacin (with fluids) and nebulization with:

10cc sterile saline
2.0cc amikacin (50mg/ml)
1.0cc aminophylline
0.3cc acetylcysteine (20% solution)

twice a day. Cuppage after treatment (gentle tapping of the ribs to loosen gunk in the lungs) also  can really help.

I'm no expert on reiki or acupuncture, but if it doesn't hurt, it might not hurt to try.

I hope he'll be better soon!

Dana