Lara (detailed diary)

Wonky Bunny: Lara
Bunny slave: Katy (UK) – owner of On The Wonk

Lara Case Report Diary – Very detailed! A brief version will follow, but I thought that some people might find the detailed version interesting.

Headtilt (Pasteurella / inner ear infection)

Report runs from: April 2006 to July 2006 (in order to cover full range of
symptoms, treatment and recovery)

Owner: Katy Hill

Lara details: 18-month-old female lop-eared rabbit. Not spayed. No previous
health problems.

NB: the first vet (Vet B) proved to be non-rabbit-savvy! I have added a number of comments when information provided by this vet was debatable (to say the least)!
The second vet, Simon Maddock, is a fabulous rabbit specialist in my area (Northampton, UK) who I still take my rabbits to now 🙂

During month of April:

Lara showed occasional signs of nasal congestion – grunting noises while eating (congested), sneezing, slight nasal discharge (off-white). No wheezing or rattling noises from chest area, no other problems. These symptoms would last for a couple of days at a time and then disappear again. The symptoms were linked to repeated nest-building times during phantom pregnancies and possibly erratic weather (hot then cold and wet). I did not act on these symptoms (which I understood to be signs of mild pasteurella) as there appeared to be no further complications and they cleared up by themselves very quickly. After the symptoms repeated 3 times I decided it was time to take Lara to the vet. I did not go earlier as I’d been advised that some bunnies could recover from mild symptoms of pasteurella themselves – as if they were suffering from a cold. However, waiting to take Lara to the vet meant that I was too late! Lara suddenly started to display headtilt symptoms just after I had made this decision. I always regret not acting earlier!

Mon 24th April, mid-evening: (down)

Sudden onset of headtilt symptoms: began with slight loss of balance as running around the garden (misjudging turns and leaning to the left as jumping, therefore losing balance and falling over). This immediately worsened to loss of balance while hopping slowly (leaning to one side).

As a result, she went inside her hutch and sat hunched up in the darkest corner where she could be supported on two sides.

It was both of my rabbits’ feeding time (pellets plus vegetables) which she normally eats straight away (and with vigour!), but Lara refused to eat or move. This confirmed to me that there was a serious problem and, after some research on the internet (see http://www.rabbit.org/journal/3-8/head-tilt.html) I realised that this was most likely headtilt caused by pasteurella / inner ear infection as this matched her previous symptoms (congestion, sneezing, slight discharge from the nostrils).

My two rabbits (Lara and Hopscotch) normally lived outside together, but I brought Lara inside so that I could keep a close eye on her. Once she was settled (again, sitting hunched up, head tilted to left a little, not daring to move), I held out pellets, vegetables and hay for her, but she was not interested. I then collected together some fresh grass, leaves and twigs (standard food I give both rabbits every day – hereon called ‘greens’) and she did eat these.

Lara would occasionally move about a small amount, but very tentatively, and would quickly go back to sitting hunched up.

Cause of sudden onset: she had been in a new environment during the day (a new run in a section of the garden she had never been before). The change of environment was stressful for her, but instead of triggering her usual mild pasteurella symptoms it triggered headtilt.

Action taken: I called my usual vet practice, but as it was out of hours, I spoke to someone on the emergency cover line. I described her symptoms (including the previous mild pasteurella signs) and that I thought she had headtilt.

I was told that it was not necessary to bring her in to the emergency hospital yet, but to keep her comfortable in a cardboard box with towels, keep an eye on her, syringe water into her (but don’t upset her with syringing). I was told that it would be OK for Lara to miss one meal if she was refusing to eat, because the reason for refusing food was not because of an intestinal problem, it was because of her distress. The vet advised me to wait and see a vet the next morning, unless she continued to deteriorate. He said only bring her in if she’s collapsed – lying on her side, unable to get up. Because of the cost and because treatment would take time to take effect, he told me it was best to wait until the next morning.

HOWEVER…! I was not confident of this advice because a) it is generally very risky if a rabbit stops eating – even though this was not an intestinal problem, the gut still needs to keep moving, and I did not want to cause any additional complications. Plus she would need food for energy to combat her illness. b) waiting until she had ‘collapsed’ seems a bit late to take her to a vet! Since rabbits can deteriorate so quickly it would be particularly important to avoid reaching this stage before treatment is begun. c) if treatment takes a while to take effect then it would seem sensible to begin sooner rather than later. However, because I was not happy with this conversation, with someone who would be looking after Lara if I took her in for emergency care, I decided it would be better to keep her at home for the night and consult with people ‘in the know’ online.

As a result, I stayed up most of the night with Lara making sure she was as comfortable as possible, eating greens whenever possible and generally not deteriorating further.

Tue 25th April – next day (same)

I called my usual veterinary hospital and tried to make an appointment for that day with the usual known rabbit-savvy vet, but unfortunately she was on holiday for the week. Instead I made an appointment with a vet I’d not heard of before… (another mistake!).

By the time of the appointment (about 5pm) there had been no further deterioration in Lara’s headtilt. She was still only eating greens, so had missed a lot of her main food intake.

Tue 25th April – initial consultation with stand-in vet (who unfortunately I cannot name. So I’ll call her vet B!)
Vet B examined Lara – including checking her cheek teeth. I explained about the pasteurella symptoms Lara had displayed on and off during April and how I thought they could be linked to the headtilt. Vet B said the headtilt could be caused by an inner ear infection or EC (Encephalitozoon cuniculi). The main outcome of the appointment was that Lara should stay at the hospital for treatment and further assessment, and that Vet B would call me the next day with an update.

Her weight was 2560g.
Treatment given:
Panacur 2.5% (20mg/kg/95cl). Given 2.05mls one dose.
Baytril 2.5% (5mg/kg/sc) 0.512 one dose.
Protexin (probiotic) one dose.

Wed 26th April – telephone consultation with Vet B (same – possibly bit better)
Vet B told me that she was treating Lara for both pasteurella (with a Baytril antibiotic) and EC (with a Panacur anti-parasitic treatment for 5 days). She suspected it was most likely EC that was causing the headtilt, although I did think that given her previous pasteurella symptoms that it seemed more likely to be pasteurella / inner ear infection.

Lara was being syringe-fed Oxbow Critical Care as she was not eating enough by herself.

Vet B explained that headtilt is a hard condition to treat and that the first 3–4 days would be crucial. She also said that if Lara didn’t show signs of improvement in that time then she probably wouldn’t improve. (NB: This point is most definitely debatable!)

Vet B said that Lara was no worse after her first night and day in the hospital, she seemed content, bright-looking. She said that she had a significant headtilt, but she hadn’t rolled. She said she was static, if not a tiny bit better.

After researching headtilt further on the internet and talking to other rabbit owners who had helped their rabbits through this disease, I asked Vet B about the use of steroids in Lara’s case, and she said that she would only use these as a last resort because of their detrimental effect on the immune system. (Another debatable topic!)

Her weight was 2470g.
Treatment was:
Panacur 2.5% (20mg/kg/95cl). Given 2.05mls one dose.
Baytril 2.5% (5mg/kg/sc) 0.512 one dose.
Protexin (probiotic) one dose.
Syringe-fed Critical Care (CC) 6 times across the day, taking lots (35mls at a time). Later she ate well by herself – veg. and grass.
Metachlopromide (gut mobility drug) 0.25ml given once.

Wed 26th April visiting Lara (same – possibly bit better)
When I visited her that evening she was looking about the same physically as when I took her in on Tue, a tiny bit perkier but still very ill-looking. Her head is definitely tilted and she’s off balance, although not spinning. She ate some carrot and apple in front of me plus greens. According to her records she had eaten a lot of syringe feed and been eating well by herself (veg and greens).

Thursday 27th April visiting Lara (down)
Going by Lara’s records, she had been losing weight over the past two days. Although she was still eating the greens that I was bringing in and lots of the syringe feed, she didn’t seem to be eating much hay. She looked particularly sad and ill today. Head possibly slightly more tilted.

I saw Lara dragging a hind leg slightly while I was there, which I hadn’t seen her do before. It didn’t look like paralysis, by any means, just like she had less control over her movement. I also saw her eye moving repeatedly back and forth (horizontally). When I spoke to other rabbit owners later who’d helped their own rabbits through headtilt, I was told that these were signs that the infection was getting worse, which was unfortunately to be expected. Apparently it is quite common that rabbits with headtilt get worse before they get better.

Weight = 2395g
Treatment given:
Panacur 2.5% (20mg/kg/95cl). Given 2.05mls one dose.
Baytril 2.5% (5mg/kg/sc) 0.512 one dose.
Protexin (probiotic) one dose.
Syringe-fed CC, 5 times through the day (average 30 mls at a time). Notes state that Lara was losing weight, therefore it was decided that they would keep up syringe-feeding and possibly increase to every hour.
Metachlopromide (gut mobility drug) 0.25ml given twice.

Conversation with Vet B on Fri 28th April
Vet B said that Lara had been eating well and put on lots of weight (300g), so they would cut down her syringe feeding to every four hours as she was heavier than when she had come in to the hospital. This was a good sign.

I asked Vet B about the rhythmical movement of Lara’s eye and how she had been dragging her hind leg the day before, and she said that they were expected neurological signs.

Vet B said that Lara’s notes state that her headtilt is lots worse and that she has started spinning. When I questioned this she said that she only spun once, when disorientated from being picked up and put down.

In general Vet B said that Lara’s not exactly worse, it’s a good sign that she’s eating.

I asked her whether, like in cases of headtilt I’ve read about, Lara could get worse before she gets better. Vet B agreed that this was possible.

She said that Lara needs to finish her course of Panacur (she’s giving her 7 days of Panacur instead of the usual 5-day course [NB *another* strongly debatable point!] because of the forthcoming bank holiday) and then she can review her health. She said that she would like to discharge Lara on Tuesday, but that she would need to discuss this with me on Tuesday 2nd May.

I asked about the possibility of using two antibiotics at once based on the advice of another rabbit owner and her specialist rabbit vet who had successfully treated a case of severe headtilt. Vet B did not think this was a good idea as she said that antibiotics don’t do nice things to rabbits, which could lead to further complications [Me: ‘Oh please!’]

Friday 28th April visiting Lara (improved in some ways, but head more tilted)
Her head looked more tilted than yesterday, not too bad, but slightly worse. But she’s a lot livelier than yesterday. She nibbled on carrots and apples and greens that I’d brought in. Her eye was no longer moving from left to right as it was yesterday. And she wasn’t dragging a hind leg today at all – just normal wobbliness.

She seemed more able to balance and groom herself today than since she first became ill – even washing the bottoms of her back paws! So she must have been feeling a lot more balanced than she was. But quite often she would be startled by a noise whilst grooming and balanced, and so wobble over. This was still an improvement on the day before, however.

Weight = 2665g
Treatment:
Panacur 2.5% (20mg/kg/95cl). Given 2.05mls one dose.
Baytril 2.5% (5mg/kg/sc) 0.512 one dose.
Protexin (probiotic) one dose.
Syringe-fed CC 4 times across the day (every 4 hours).
Metachlopromide (gut mobility drug) 0.25ml given twice.

Sat 29th April (deteriorated)
Lara had deteriorated further. Headtilt angle worse.

Weight unknown
Panacur 2.5% (20mg/kg/95cl). Given 2.05mls one dose.
Baytril 2.5% (5mg/kg/sc) 0.512 one dose (last dose at Spinney)
Protexin (probiotic) one dose.
No syringe feeding
Not known if Metachlopromide (gut mobility drug) was given today.

Sat 29th April conversation with Vet B
Vet B mentioned today that EC is more prevalent than inner ear infection, but added that it was possible that Lara could have both EC and pasteurella / inner ear infection. [The point about Lara likely having EC as the *primary* cause is extremely debateable too.]

Because of Lara’s deterioration, Vet B said that she was considering changing her antibiotic from Baytril to Tribrissen (trimethoprim/sulfadiazine). [A debatable choice.]

She also said that they had stopped syringe-feeding because Lara had been eating lots of greens and had started to eat hay. [A bad decision!]

She said that rabbits who don’t survive headtilt (that are put to sleep) aren’t eating by themselves, they refuse all food and start rolling, stumbling lots, and are distressed. [I quickly learnt that yes, a rabbit with an appetite is presenting a will to live, but some just aren’t *able* to eat by themselves. They need a helping hand. Also, the rolling/stumbling is not a sign that they will not survive!!]

Barbara said that her headtilt is definitely at a worse angle today, *but* she is healthier looking and more alert (kicking hay about, etc.)

Sun 30th April (deteriorated)
Lara had deteriorated again. Headtilt angle quite severe now.

Weight unknown
Panacur 2.5% (20mg/kg/95cl). Given 2.05mls one dose.
Treatment:
No Baytril
Tribissen antibiotic (trimethoprim/sulfadiazine) – dosage?
Protexin (probiotic) one dose.
No syringe feeding
Not known if Metachlopromide (gut mobility drug) was given today.
NSAID – Rimadyl (carprofen) – dosage?

Sunday 30th April conversation with Vet B.
Vet B said that Lara was not so good today, that her head was more tilted again. She said that if Lara is worse again she will be falling over. This is her worst day so far. If she gets any worse then Vet B will be quite concerned. On plus side she is still washing herself.

She has changed the antibiotics to Tribrissen (trimethoprim/sulfadiazine) and she’s now on an NSAID – Rimadyl (Carprofen) – (so she has the effects of a steroid but with less side effects). Vet B also repeated that she would only use steroids as a last resort [again, debatable!].

She said that she was offering all the treatment that she could at this point, so it was then a case of sitting tight and waiting to see how she does. [I now say ‘Hmmm!!’]

Vet B also said that Lara’s eye was flicking again this morning, but not this evening.

She agreed that this marked deterioration has been since she changed her antibiotics, but she also said that Lara hadn’t been responding well to Baytril. She said that Lara had initially responded quite well to the Baytril and then her progress had been up and down.

Monday 1st May
Weight unknown
Treatment:
Panacur 2.5% (20mg/kg/95cl). Given 2.05mls one dose.
No Baytril
Tribissen antibiotic (trimethoprim/sulfadiazine) – dosage?
Protexin (probiotic) one dose.
No syringe feeding at the surgery, but lots at home throughout the night.
Not known if Metachlopromide (gut mobility drug) was given today.
NSAID – Rimadyl (carprofen) – dosage?

Monday 1st May (bank holiday) – conversation with the vet nurse (Known as ‘R’ hereon) (vet covering for Vet B).

R said that Lara was really deteriorating: she’s spinning, can’t stand up and isn’t feeding herself. She said that she didn’t think Lara was going to recover and that she thought it was time to put her to sleep. [I say: ‘So wrong!’] When I went in to the vet hospital to assess Lara’s condition myself I found her standing up by herself and eating hay voluntarily! I took Lara home with me as I disagreed with R’s reasoning wholeheartedly and as soon as she was home she ate greens by herself and lots of syringe feed, and she wasn’t spinning as often as I had expected from what R had said.

R also said that Lara had now finished her 7-day course of Panacur for EC, and that she was still deteriorating. She explained that when the EC parasites die they are still in the brain, so they can still continue to cause problems as they release toxins into the brain. For this reason she is not going to improve. [Looking back, I have realised that this reason for putting Lara to sleep was totally unfounded as she did not appear to definitely have EC. Pasteurella / inner ear infection was her primary cause of headtilt!]

I told R that I wasn’t prepared to give up yet as I have heard from many other rabbit owners and the owner of a rabbit rescue centre – who have nursed their rabbits through headtilt – that spinning is a common part of headtilt and that it can be overcome in a lot of cases with the right treatment and time.

I was more than aware that headtilt at the spinning stage is very distressing for rabbit and owner, but in a lot of cases this is part of the course. I believed it was necessary to give Lara a chance to fight the disease and pull through like many other rabbits have, especially because she has shown such fighting spirit so far. The fact that Lara has continued to eat (whether gobbling up the syringe-feed three times more than a normal rabbit, or continuing to eat greens) and shown determination so far to overcome this disease, proved to me that I should give Lara a chance to pull through this.

When I asked R if I could take her home and medicate her until I could find a specialist rabbit vet the next day – given that it was currently bank holiday Monday and no other vet was taking calls – I was told that ‘it would be cruel to keep Lara alive’ because ‘she would starve to death’. [Proved wrong!]

Unfortunately, when I insisted on keeping Lara alive – having seen her demonstrate that she could eat for herself and that she wasn’t nearly as distressed as R had said – and taking her home with me so that I could get her to a specialist vet the next day – I was refused any effective medication. She gave me a small amount of Panacur (which actually wasn’t necessary in Lara’s case) and some Critical Care (which was invaluable – thank goodness they gave me that!) but no antibiotics or NSAIDs (not even oral versions).

When I went in to the hospital to assess and collect Lara, R said that she ‘had never seen a rabbit spin before. It was very distressing.’ (I found this very worrying. How could someone this inexperienced in headtilt insist that I have Lara put to sleep, when so many people were saying otherwise?)

There was no opportunity to try steroids or stronger antibiotics at this veterinary hospital, which I felt needed to be explored. [Vet B had said she would try steroids as a last resort… But this option was never given a chance at this hospital.]

Mon 1st May when home
I saw Lara’s eye moving back and forth again and this was the point when I read the article (www.medirabbit.com/EN/Neurology/otitis_interna_media.PDF) that reveals Lara’s primary diagnosis: inner ear infection / pasteurella.

When home and settled indoors, Lara ate happily on syringe feed and some fresh leaves from the garden. She would spin, but she would lie still and eat from the syringe if I gave it to her in her makeshift bed (a plastic tub with high sides to stop her rolling around, and with towels at the edges to stop her hurting herself) rather than picking her up and disorientating her. I also put greens in her bed, which she would find and munch on as she rolled over.

Monday evening – conversation with the emergency vet for The Cat and Rabbit Care Clinic (here called VN)
I spoke to the head nurse at VN and she agreed that I had done the right thing, bringing Lara home and not having her put to sleep because she was still eating and showing strength, plus the fact that it sounded more like pasteurella than EC. She recommended that I look after Lara closely tonight, feed her Critical Care and make sure she drinks water. It’s essential that she eats, drinks and keeps passing food through. Get her through the night and to a specialist vet asap the next day.

This nurse also said the other thing Lara needs is time to treat headtilt!! [She was absolutely right!]

Monday 1st May (first night at home)
As soon as I got Lara home I put her outside in the garden (her usual environment) where she ate twigs and leaves that I put on the ground. She was obviously hungry and able to eat by herself.

She did roll a few times but I just held her still, gently, to help her get her bearings. Once she’d had some fresh air and knew where she was again, I got her settled inside so that I could keep a close eye on her through the night. I made a makeshift cot for her out of a plastic tub with towels rolled up at the sides to protect her from hurting herself as she had too much room to roll around on a hard floor otherwise. This worked well. She soon settled down and calmed down.

Through the evening and night she had more fresh greens and syringe-fed Critical Care (all of which she ate very hungrily!) and Protexin probiotic too. She even ate a few small pieces of banana and veg. I syringe-fed her water every now and then.
She was passing fluids and faeces (some cecil-like and some firm and round).

I noted that her eyes were looking weepy and there was a little discharge from her nose again during the night – more signs of pasteurella.

I also noticed that her body temperature would drop and she would appear weaker when she was hungry – this would happen every couple of hours. Then when I’d feed her she’d eat loads. I decided not to worry about weight issues here and just get her through the night on food as this is what she seemed to need!

I was able to calm her down when she spun by stroking her gently and distracting her with greens. She would soon stop spinning and either eat or tooth purr. This proved that keeping her calm and relaxed would decrease the amount of spinning she did.

Later in the night she was showing strength and determination when she got cross at being confined in a cot – she would chew angrily at the towels and between spinning she would try and sit up and look around her, contemplating getting out of the cot. I could not risk her being out of the cot, however, as she would have too much room to roll around the hard floor, and possibly hurt herself. She could not walk at this stage without spinning. Most of the time she was settled though. This continued throughout the night.

Lara had runny eyes on Monday 1st May evening. Seemed much less stressed on Monday night because she was back home. When I went to collect her she flipped once a little but not over and over. She then stayed perfectly still in my arms all the way home. There was some flipping while she adjusted to her new environment but then she settled. She only flipped during the night when something startled her, but there’s much less to startle her at home (no dogs howling, and other strange noises to a rabbit like at the vets) so she’s calmer, so she spins less. Eating, pooing and weeing like crazy all night. Tuesday early hours, Lara very keen to be out of her box, sniffing the air, wanting to be up and about. Still eating pooing and weeing.

Tuesday 2nd May First visit to The Cat and Rabbit Care Clinic
Appointment with Simon Maddock. I explained why I had come to him and he agreed to treat Lara. He told me that yes, it was most likely that Pasteurella was the cause of Lara’s headtilt, but that this cause is the hardest to treat. He checked the movement of her eye, back and forth, and stated the meaning of this before I could reach for my article showing this!

He said that he would review her progress after 5 days of treatment. I agreed with this, as she was obviously at a critical point in her illness. I realised we had to fight extremely hard to make her better and that she might still not make it – but it was worth a try.

Simon agreed that it was best for Lara to stay at home and just come in for injections during this critical period since she was less distressed (therefore eating more and spinning less) at home.

I went into the consultation with a treatment plan based on other rabbit owners’ experiences with headtilt caused by inner ear infection / pasteurella. But I did not need to start talking through this, as Simon was already set on this same course of treatment! He said – again, before I could – that now was the time to use the ‘big guns’ medicine. Lara had severe headtilt and, as I had expected, we needed to take risks by using aggressive treatment.

His treatment plan was to give Lara a Dexamethasone injection (a low-dose steroid) every other day, a Baytril injection and a penicillin injection daily for the five-day period stated. Penicillin details: Duphapen 0.35ml once a day. If this course of treatment was successful then he would change from penicillin and Baytril combined injections to Azithromycin (Zithromax), which works directly on the tissues, therefore hitting the infection directly. He also prescribed more Panacur so that Lara could continue her course – which I administered to the end of its 28-day course. Despite not believing that EC was the cause of her headtilt he thought it wise to see the course of treatment through for the full 28 days – to avoid complications later with resistance to EC. Panacur details: susp 10% – 1ml x20, giving 0.6ml once a day.

He said that Lara will need time out of her protective cot so that she can learn the new angle of her head. This will be her way of learning to cope, and to learn to balance again. I agreed to put her outside in the garden (in her old environment) daily, then, so she could practise.

Tuesday 2nd May at home
She ate and drank through syringe feeding during afternoon and night. Still eating a lot. I was still giving her Protexin probiotic as well. She was relatively relaxed, in between shredding newspaper in her bed and chewing towels. She would spin when something startled her, but could be calmed down by supporting her and stroking her again.

Throughout this time she seemed to have more energy for spinning and eating, but she was also more peacefully rested when asleep.

I took her outside in small doses and she loved it. She would instantly perk up in the fresh air. I made barriers to stop her falling down slopes on the grass, but she had quite a lot of room to move about and the grass softened any falls and spins. She would roll a lot when I first put her on the grass, but after a while she’d get her bearings and learn to balance a little at a time. She ate lots of greens outside that I put on the ground for her.

Inside, she was cleaning herself more again, and not dropping in temperature between feeds.

During this time, when she spun she would become quite twisted and curl up into a tense ball, head tilted right to the ground. Simon later described this as one of the most severe cases of headtilt he had seen. She spun more tonight than yesterday evening (Mon). She seems more restless, but then yesterday she kept lying very still with her body temperature dropping – hence how she seems to have more energy for spinning, so maybe it’s not such a bad thing?

She did lots of tooth purrs as well. She relaxes a lot in between spinning. But her eye moves back and forth and bulges when she’s particularly stressed.

Weepy eyes and congested nose (which has had since Saturday night). She only spins when stressed. The rest of the time she’s calm in her box.

Today (Tue) in the garden: She immediately ate greens on the floor, then spun a bit because she was disorientated, then hopped about and hardly spun at all after that. Her headtilt angle improved for being outside in her old environment.

She’s eating lots of syringe feed (CC) and passing it through her system perfectly.

She had a very restless spinning time after she came indoors, but then she ate loads and loads and chilled out – licking her paws and tooth purring.

Wednesday 3rd May vets (Cat and Rabbit Care Clinic)
Lara nicely chilled out before went to vets. Past 48 hrs keeps trying to straighten up and sit up – persevering/determined.

Saw Simon again and he administered her Baytril and penicillin injections again.
I was told to keep feeding her as often as possible, to keep up her strength.

I explained her progress and Simon told me to continue as I am, keeping up the time outside.

Wednesday 3rd May at home
I changed my method of giving her water: I swapped the syringe for a standard rabbit drinking bottle (holding the bottle for her). This was much easier to administer and Lara was happy with this too.
I continued the same as yesterday in terms of food and letting her outside. She spent most of her time in her cot for protection but enjoyed her times of more freedom in the garden too and spent the time learning to move again and enjoying the fresh air.

Lara’s been up and down. She’s still spinning whenever she hears a loud(ish) noise. Still having trouble righting herself.
She had an off patch this afternoon when she wouldn’t eat much, stopped grooming and started to look quite sickly again. Her steroid might be wearing off – but she’s due another injection of it tomorrow.
Later I managed to get her to eat lots of CC though and encouraged her to groom herself.

She had a little time in the garden today and she was standing up and trying to straighten her headtilt slightly, which worked for a while. She spun quite a lot when first put her outside, as disorientated.

She’s been trying even harder to get out of her box inside – pulling herself up into a standing position, holding onto the top edge of the box with her front paws.

Thursday 4th May vets (Simon)
Lara given her steroid injection, plus her Baytril and Penicillin injections and a general check up.

Tried to escape out of her open-top box (as can’t easily get her in her carrier at the moment) on way home, so she’s definitely feeling a lot better. Very inquisitive.

Thursday 4th May at home
Outside in the garden quite a long time today and has learnt how to balance a little through digging. Getting better at balancing generally while in the garden, although she certainly still tumbles a lot, but still making a little bit of progress each day.

Not wanting food at one point today again – hours without syringe-feeding. But then later ate loads of CC.

Spinning quite a lot still today. She does well outside, learning to balance standing up, but once she comes indoors and goes back in her cot she spins a lot – possibly through frustration at not being able to move about.

Friday 5th May at vets (Kim)
Lara given Baytril and Penicillin injections. Took them very calmly.

Good to see another vet – new perspective. Kim helped me see that I needed to alter Lara’s cot now that she’s not spinning as much. I made a small run that would fit inside the house and laid lots of vet beds around so that she had protection when spinning.

This way Lara could have access to hay and fresh greens permanently. It’s been hard to give her access to these in the cot as every time she spins the food flies out of the cot! This way I could attach the drinking bottle inside the run too so that she also has permanent access to water.

Kim gave me some Fucithalmic antibiotic eye ointment as Lara’s eye that was nearest the floor was becoming very swollen and red from rubbing on the ground.

Friday 5th May at home
Astounded at Lara’s progress today.

Lara stayed out in the garden for a good hour today, at least, and I didn’t see her stumble except when she was first outside and getting her bearings/balance – and even then she did not stumble much.

She has been digging and balancing well. She also nibbled on fresh greens and hay while outside.

She hardly flipped/spun this evening – a huge step forward. It was her first night in her run enclosure and she managed to get around. Perhaps not spinning because not frustrated at being confined to her cot. She edges around the side of the run to wherever she feels like sitting and eats lots of hay and greens, and veg. She’s been moving about in a much more controlled way.

Lara had her usual syringe food, fresh greens and hay, probiotic, water and now eye ointment too.

Saturday 6th May at vets (a locum vet)
Lara given Baytril oral to take home and Penicillin and steroid injections (last of steroid).

Given oral Baytril to administer on Saturday and Sunday at home, as the vets will be closed. Baytril (oral 0.6ml, twice a day. Baytril suspension 1ml x10).

Saturday 6th May at home
Eating lots of hay and fresh greens and pieces of veg in her run. She’s also drinking well from her bottle in the run. She’s hardly spinning at all now. The new environment is working for her – she has more freedom, therefore less frustrated, and she can continue to learn to move around / find her balance with her tilted head.

I was amazed to see her scratch her ear with her back paw, then clean between her claws on that back paw – this took some balance!

She is moving her head in new ways when moving as if to test how to look.

Gave her Baytril oral (consistently as per instructions until course completed).

Sunday 7th May at home
Lara slept and ate well and looked healthy and happy. Eating lots of fresh greens and veg. Syringe feeding still. Getting more tooth purrs from her today.

Cleaned up her eye and put drops in (as usual) and her bad eye doesn’t look as bad today.

During her outside time it took her a while to settle and she seemed tired, so dug a little bit then sat still. Seemed happy enough.

Once back in her run she was very tired still. Ate some fresh greens but not as ravenous as usual.

Monday 8th May vets (Simon)
Lara more relaxed at the vets – actually groomed herself while there.
Simon showed me how to inject penicillin into Lara so that I could administer this from home. He also gave me oral Baytril to administer twice a day. Her weight today was 2.47.

Monday 8th May at home
Baytril oral again. Eating fine but not wanting usual enormous amount as seems a bit tired still. She does eat fresh greens and hay when hungry though.

Noticed that one of her eyes was bulging a bit again (like used to at spinning stage) and she was stumbling a bit more. She also sneezed a little late in the night and her head seemed a little more tilted again. Could be that the steroids have worn off – therefore might be a good idea to start on Metacam (NSAID) now that we’re through the worst but needing something extra.

Changed food so that don’t have to syringe feed, but somewhere between that and giving her dry pellets which she won’t eat. I mashed up the pellets with a little water and Critical Care – so that it was the consistency of mashed potato – and gave it to her on a plate with veg. She ate it during the evening! Means she can now eat pellets and Critical Care independently whenever she’s hungry. She still continued to eat hay and fresh greens.

Tuesday 9th May at home (am – early hours)

Lara stumbled and spun when moving around her run. She hadn’t done this for a while so it was a worrying sign on top of Monday’s slight deteriorations. She went to settle in a safe place where she was supported all round. This is more evidence that she probably needs an NSAID like Metacam (which lots of other headtilt rabbit owners have recommended). She spun again later after administering meds, and her eye bulged again. Also doing a regular sneeze. Bit more of a headtilt angle too.

But she was eating very well again (still eating mashed-up pellets and Critical Care from a plate plus lots of fresh greens and hay) and passing food through perfectly.

Gave her usual Baytril and Panacur and eye ointment.

Tuesday 9th May pm
Administered first penicillin injection from home. Lara sat still. Spoke to Simon re Lara’s slight dip and as I thought he gave us some Metacam (NSAID) oral to try. He said to monitor her for 2-3 days and if she’s no better than he would switch her to a new antibiotic. Said to call on Wednesday to let him know her progress. Metacam details: 10ml x1, given 0.25ml once a day).

Later in evening Lara had more mashed pellets and CC on plate, plus veg. She also continued to eat more greens and hay. Eating lots generally.

Also gave her Baytril and Panacur

Wed 10th May am (early hours)
Lara had Baytril oral, Panacur and eye ointment. Lara spun and made snuffly/congested noises while trying to administer this. At this point I wondered how long it would take for the Metacam to work, or whether this dip wasn’t necessarily because of the reduction of anti-inflammatory meds but because we had switched to oral Baytril instead of injectable. I tried stroking her to calm her down – as used to work before – but she didn’t relax and she was hot with a fast heartbeat. I put her back in her run area (I’d had been holding her to administer meds) and she span a lot with fast heartbeat still. Her eye was bulging again as well as moving repeatedly back and forth. Once she was in her run area and got comfortable again her heartbeat started to return to normal. She nibbled on some food and this helped her to calm down. We were back to the point where moving her really disorientated her – hence the spinning as I had picked her up to give her the meds, and then had to get her settled in the run again. The movement had set her off balance.

Wednesday 10th May pm
Gave Lara her penicillin injection, Baytril oral, Metacam and eye ointment. Then I put her straight outside in the garden. She spun a lot when I put her on the ground as she tried to get her bearings. Once she got her balance back she didn’t spin very often. She did some digging and then rested under a box (which perhaps provided security/stability as well as shade during the sunlight). She stayed outside for 3 hours and seemed content once settled.

On putting her back in her indoor run, I was surprised that she didn’t spin. She slept well and ate some greens. I made a point of giving her attention without administering meds, etc., and she seemed to enjoy this. This helped increase her trust again – from this point onwards in her recovery I made time to continue this.

Lara ate well this evening – mashed pellets with CC on a plate, veg, hay and greens.

She seems to have levelled off in her dip today, not got any worse, but then not improved back to her previous status the other day. Perhaps Metacam is starting to work.

Thursday 11th May am (early hours)
Lara hadn’t been moving around in her indoor run very much and I realised I’d been blocking her path with bowls and toys. She gets around the run by having a wall on her left side for support if needed. I therefore moved all obstacles to the middle of the run to give her a clear path around the perimeter of the run. This worked and she moved around the run after that. She seemed quite content – eating, passing food perfectly, grooming and sleeping.

Administered Baytril oral, panacur and eye ointment, but Lara was not happy. She had the meds but fought against it.

Thur 11th May pm
Administered penicillin injection (bit restless during injection), Baytril oral, Metacam and eye ointment, then put her straight outside again. She spun quite a lot again but then settled down once got her bearings. This shows again that it’s the movement (picking her up and placing her down) that sets her off balance and causes her to spin.

Lara stayed outside for 4 hours today. Once stayed in one place for a while then learnt how to hop up the garden (this portion was about six feet long). She stayed there for quite a while and nibbled at the grass. She seemed content again.

When I brought her into her inside run she spun only once on entering the run and nibbled on hay and greens straight away to steady herself. Still eating mashed pellets and CC plus veg, too.

Fri 12th May (pm)
Administered penicillin injection, Baytril oral, Metacam and eye ointment. I did this while she was in her run this time, so I didn’t have to pick her up and upset her balance before giving her meds. This worked well – she was a lot calmer. I put her outside in the garden afterwards and she spun a bit then settled.

Outside, same as yesterday, spins when first down on ground, then finds her bearings, hops to somewhere comfortable and sits and eats greens and maybe digs a little bit and relaxes.

Sat 13th May am – early hours
Administered Baytril oral, Panacur and eye ointment. Fighting against the meds a bit but not spinning.

Sat 13th May pm
Administered Penicillin injection, Baytril oral, Metacam and eye ointment. Bit restless while trying to do injection and putting up a bit of a fight with oral meds. This is more Lara’s frustration – fighting against having the meds – than stressed and spinning which is a positive sign in a way. Then put her straight outside in garden. She didn’t spin once this time.

Sunday 14th May am early hours
Administered Baytril oral, panacur and eye ointment. All fine.

Sunday 14th May pm
Administered penicillin injection, but she moved halfway through so only managed to get 0.25ml in. I tried to get last bit in with new needle, but she moved again so I stopped as didn’t want to distress her further. Her restlessness with the injection has been increasing. I wondered at this point whether it was time to change from penicillin to the next antibiotic as previously discussed with Simon. Some rabbit owners have reported a hardening of the skin after injecting the rabbit over a week or so, this is possible with Lara, therefore making it more uncomfortable for her. The new antibiotic would be oral which would avoid this problem.

Administered Baytril and Metacam, this time mixed in with some apple puree to avoid her struggling to take it. This worked better as they tasted nicer.

Once outside, Lara showed such determination in wanting to move about (goes with the frustration she’s been showing with taking meds lately, like she’s getting back to her old self). She pushed aside the barriers I’d placed in the garden to contain her in a small area, and explored the whole garden (the biggest area she’s been in yet). She did keep losing her balance and falling over, spinning two or three times – but not uncontrollably – then she’d lie on her side to get her bearings, stand up and carry on hopping around the garden! If she fell over and spun more than 3 times I’d step in and help her stabilise, but her heart wasn’t racing or her eye bulging at these times – she had more control than when she used to spin. She was learning to control the spins – starting to use them – and to adapt to the angle of her tilted head.

Mon 15th May am early hours
Administered Baytril oral (without mixing with apple puree this time) and Lara really put up a fight – chewing the syringe angrily – but I managed to get it all in her mouth. She took the Panacur, but was not happy with this either. Again there was no stressed spinning, she was just annoyed at taking meds – showing her strength of character.

Mon 15th May pm
Simon swapped Lara onto the new antibiotic (Azithromycin – tradename Zithromax) so she would no longer be taking Baytril oral or Penicillin injections. We agreed to keep her on Metacam for now (which she has been on since 9th May, therefore 6 days). Zithromax suspension (Azithromycin) 200mg/5ml (susp 15ml x1). Give 2.5ml once daily orally for 5 days (Tue 16th to Sat 20th May) then once on Mon 22nd and Wed 24th May, continuing twice a week after that.

Once home I put Lara outside and she immediately explored the whole garden again. She had some time relaxing/sitting down and then went off exploring again. She was outside for 3 hrs doing this. Less spinning than yesterday.

Lara ate lots of food this evening: pellets and CC mashed up on plate, plus veg, greens and hay. Her weight today was 247 – stabilised, even gained a little bit. Her diet is good then as it is: mainly greens and hay with some pieces of veg plus pellets and CC mashed together.

Tue 16th May am early hours
She was spinning occasionally during the morning – possibly because the Penicillin and Baytril were wearing off and she was only just about to have first dose of Zithromax, therefore caused small dip. But she was still bright.

Gave Lara her first dose of Zithromax oral and she loved it. Also gave her Panacur which she wasn’t too keen on, so mixed with her food – more annoyed with taste than stressed, therefore not spinning during administration of meds.

Tue 16th May pm
Administered Metacam

Wed 16th May am early hours
Tried to administer Panacur but Lara wouldn’t take it. A lot of it missed but wasn’t sure how much she’d eaten, so left it at that and decided to mix it with food the next day as it’s the taste that’s putting her off.

She was then unhappy about taking Zithromax (because she was generally annoyed). I didn’t get all of this in her mouth either.
She hadn’t been outside in the garden during Tuesday, so it’s possible she had lots of energy in her system and was annoyed about being cooped up.

Wed 16th May pm
Learnt to administer meds in a more calm way, gently. This meant that Lara stayed calm and didn’t get so easily annoyed with having meds.
Gave her Metacam like this.

Lara was very energetic outside (possibly emphasised because she didn’t go outside yesterday). Despite the fact that it wouldn’t stop raining she wouldn’t stay under shelter, just kept hopping around the whole garden again. This displayed true determination as she doesn’t like the rain. She picked up a lot of speed, showing that her balance was improving. She kept her balance well and didn’t fall over very much. (When I brought her inside I dried her with a towel and made sure she was the right temperature.) She seemed very content and happy.

She ate well again this evening – mashed pellets and CC on plate with veg, hay and greens

Thur 18th May am (early hours)
Gave Lara her Zithromax slowly, in between gentle strokes to keep her calmer during taking meds. More coaxing made giving meds much easier and Lara was obviously happy as she gave me tooth purrs.

Gave Panacur in same way but mixed with apple puree again for improved taste.

Thur 18th May pm
Administered Metacam in same way – all fine.

Once outside in garden I put her on the floor and she hopped everywhere straight away without falling over once! She was hopping very fast and even hopped on two side paws at one stage to make sure she didn’t fall over whilst going fast around a corner. I was amazed at her balance, energy and determination. There’s a strong link between the beginning of her Zithromax medication and this sudden energy, agility and determination.
When she had raced around the garden a few times she then stood at the door to her old enclosure (where she used to live outside with my other rabbit). She looked determined to go inside, so I moved my other rabbit out of the enclosure (to avoid any fighting since they have lost their bond during Lara’s illness), and let her in. She explored the whole of the ground floor many times over, and once she plucked up the courage she hopped into her old hutch inside the enclosure (about 3 inches off the ground – the most I’ve seen her attempt since the beginning of her headtilt). She stumbled and fell sideways in and out of the hutch both times she tried. But she didn’t spin at all, just got up and carried on. She didn’t want to come inside after being back in her usual home outside, but she still needed supervision so she had to come indoors to her run.
Today therefore she showed a marked improvement in her speed and agility around the garden and her determination to attempt a small step in and out of her hutch. Her energy was extremely high, and she seemed very happy with her progress.

Fri 19th May am early hours
Lara’s appetite has increased again. She ate more than usual: mashed pellets and CC on a plate, veg, greens and hay.

Administered Zithromax and Panacur in the same way as yesterday – all fine.
Gave her eye ointment, but she is resisting this a lot now. (I’ve been giving this to her every day twice a day until now too)

Fri 19th May pm
Administered Metacam and put her outside again. No spinning when put her on floor again (not happened for a while).

Today she achieved more in the garden. She jumped over a thick branch on the ground (about 4 or 5 inches high) and she hopped in to her hutch in the outside enclosure again without stumbling!

She was hopping everywhere around the garden, and very fast again. She wouldn’t keep still – determined to keep trying.

She also showed more determination and strength of character as, for the first time since being ill, she hopped away from me when I tried to pick her up to take her indoors again.

Sat 20th May pm
Administered Zithromax, Metacam and Panacur – all fine and calm.

Once outside she was still just as energetic as the past couple of days – going everywhere and fast. Didn’t want to come inside again – really enjoys being outside. Again she looked like she wanted to stay in her hutch outside.

Ate more dinner than usual: mashed pellets and CC on plate. More veg, hay and greens.

Sun 21st May pm
No Zithromax today (as had her 5 days, Tue-Sat) – next dose due on Mon.
Administered Metacam.

Decided to give Lara a chance to stay outside in her hutch in the enclosure. (The hutch has an extension so she’s not very confined.)

During her time free in the garden she was as energetic as usual – not staying still for a minute.

I gave her her dinner in her hutch – mashed pellets and CC, veg, hay and greens. She ate very well again.

Mon 22nd May pm (the week that Simon’s away)
Lara seemed happy after her night outside in her hutch. I let her out free in the garden as usual and she was still ultra energetic.

She is becoming even more herself – she is making ‘grunting’ noises when going to jump somewhere, like she used to do before ill. (It’s a determination grunt rather than congestion. She was not spayed at this time.)

She’s also moving her head more normally when looking about her. Balance must be improving further for her to be able to do this.

Administered Metacam and gave her lots of attention. She loved both and gave me lots of tooth purrs, showing she’s happy.

Once in her hutch again I fed her mashed pellets and CC plus hay, veg and greens. Mixed Panacur in dinner again. She was very hungry again.

Tue 23rd May pm
Lara still living outside.

Administered Zithromax and Metacam, but Lara not wanting to be picked up! Back to her usual self before ill.

Gave her Panacur in her dinner again.

Increased the amount of mashed pellets I gave her and reduced the amount of CC so just for taste. She ate all of this and lots of greens, hay and veg.

Thur 25th May pm
Metacam administered. No Zithromax today.

Friday 26th May
No Metacam today or Zithromax.

Saturday 27th May
Zithromax administered.

Treatment hereon given Zithromax until end June, twice a week. And gradually weaned off Metacam until 8th June.

In this time, Lara continued to regain her balance. Her head gradually became less tilted until it was almost upright/straight. Her left eye, which used to be close to the ground during severe headtilt stage and which was then very swollen and sore has cleared up completely. Because her head is usually tilted at about 15 degrees her left eye is always pointing a little bit down. She therefore does not use this eye as much as she used to, but she can see out of it fine when her head occasionally sits completely straight.

At the end of May I gave Lara a bowl of normal pellets (not mashed) with just a small sprinkle of CC on top and she ate all of this. I gradually weaned her off the taste of the CC from here too. So she is now eating normally (pellets, hay, veg and greens), and her weight appears to have stabilised.

At the beginning of June she started to jump on objects that were a foot and a foot-and-a-half off the ground. She would initially stumble as jumping off these, but soon learnt to balance herself as she jumped off. She started to make higher jumps – up two steps that are one foot each – but I’ve had to prevent her from doing this as she couldn’t get back down again.

She does still have limitations, therefore: in how high she can jump up (there are still some objects higher than 1 ½ feet that she used to jump on that she won’t attempt yet) and in the height of a jump down (1 ½ feet is her maximum there too). I don’t believe she has finished learning yet, though, as she is constantly looking up at these taller objects, as if working out how to jump up there.

There is always the concern too that her pasteurella will return, whether in the form of headtilt or otherwise. Since coming off Zithromax (the last of her medication), there has been no dip in her health. In fact she continued to raise her head so that, as stated, it is just 15% tilted most of the time.

I have been doing everything I can to ensure that she does not get stressed about anything, as this is what triggered her pasteurella and, therefore, headtilt originally. My main concern at the moment is that, as it is summer, she is sexually energetic. She lives in close proximity to my male neutered rabbit, although they are not living together as they are not currently bonded. But his presence nearby triggers some stress. I do not let them near each other, however, in order to avoid Lara having a phantom pregnancy which was the cause of her pasteurella and headtilt at the very beginning of spring.

She currently seems to be a very happy, content, energetic rabbit. She has suffered permanent physical damage – in the tilt of her head and inability to jump high – but she has learned to move about exceptionally well so that she is once again completely independent.

I’ve been through all this knowing there might come a point when I need to have Lara put to sleep, but that point as never arrived. She’s always shown utter strength and determination to get better, and I couldn’t argue with that. It was as hard for me to make the decision to keep her alive as it would have been to end her life. I did not make the decision lightly by any means.

It was a very difficult decision to make re coming off the Zithromax considering the risks of relapse, but we felt the time was right.

For Bunnies with head-tilt

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