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Rabbits/Persistent head tilt, now urinary problems

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Question
Copied from my question on BinkyBunny forums, 8/2/2014:
A couple months ago, my bunny started leaning his head to the left, nothing more. Vet diagnosed as head tilt/ear infection, prescribed 1 x daily injections of Baytril. These injections continued for two months, then, after a week of no antibiotics, he was perfectly fine and chipper for two days.
Then, suddenly, he began to lean to the other side. It wasn't just a lean, however; He began to flail uncontrollably and was unable to get up or stand up. His ears were burning hot. I rushed him to the vet and he said the ear infection just moved to the other side and prescribed more Baytril and steroid to help with the hot ears. Steroid did not help ears. We put a cold pack in his carrier. He's been getting progressively worse. He does show desire to eat and drink (through a dropper), and his stools are normal. He DID miss eating his caecos on his own this morning, but I coaxed him into eating most of it. I keep him either in a small carrier or beside me at all times. He shows resistance if I try to nudge him to one side or the other... Vet also gave him a shot of bicillin. I've been giving him small amounts of plain yogurt (at direction of vet) to counteract the antibiotics and prevent diarrhea. vet took x-rays to rule out broken bones. He has not taken blood tests and says that he cannot look in Wilbur's ear (he's a lop) because he won't sit still and if the infection is in the middle/inner ear, he can't even see it. He is clean from mites.
Then, just now, when I picked him up to put him in a clean carrier with new, clean towel, he uncontrollably urinated. It's like when changing a baby boy's diaper and the stream just happens. He's never done that before... And, just now, he audibly urinated on the fresh towel. He's never done that before. His ears are still warm and he doesn't seem to want to even try to walk around. His breathing is fast.
My mom was a human nurse and says that being unable to control urination is a sign of impending death...
What else can I do? He's not getting any better. This is the only vet around who takes both rabbits and payment arrangements... Do any of you have any information or experience with persistent head tilts?

Update on 8/4/2014:
Update: vet has put Wilbur on Baytril ear drops for a couple days; if this doesn't resolve, he's to receive oral sulfa-something or other, .5cc once a day. Again, this vet suggested giving plain yogurt to balance tummy flora.
but here's a kicker: remember last post when I said he peed a TON, and all of a sudden when I picked him up? He hasn't peed since. It's been at least 2-3 days with no pee. His belly does feel a little swollen compared to the rest of him (he's losing his weight slowly due to inactivity and decreased appetite). His head is tilted such and he's so disoriented he can't drink from a dish, so I've been watering him through a small needle-less syringe. I researched and found that his favorite veg, kale, is high in calcium. Is it possible that he has sludge or a blockage? What's the recourse to fix this if that is the case? My vet does not have a radiograph machine; I think all they have is an xray. Funny thing is, last time he ate kale was the last time he peed. He finished off his cilantro yesterday night.

I have tried massaging his lower belly and slightly agitating him to try and trigger another pee response. Nothing. I don't want to stress him by scaring him, because he's already stressed with being unable to stand and move on his own. What else can I do to help him pee here at home until 8 am when the vet opens?

Answer
Dear Emily,

No offense to your current vet, but I think you need to find a rabbit-savvy vet for a second opinion.  Please check the list linked here:

http://www.rabbit.org/vet

I'm not there to check the bunny in person, so this is just a guess.  But what you describe could be consistent with a rip-roaring urinary tract infection (UTI).  One shot of dual-acting penicillin is not going to help here.  He needs to be on a *constant* regimen of antibiotics, and if his condition is this severe, he may need to be on TWO antibiotics.  If this were my rabbit, I would ask about putting him on oral ciprofloxacin and injectable amikacin (this must be given in a generous bolus of lactated ringer's solution, to prevent insult to the kidneys).  

If he still has a fever, then he needs something to reduce that.  If he has a UTI, then NSAIDs (non-steroidal anti-inflammatory drugs) might not be the best choice.  But they could be the only option here.  I would suggest metacam at a dose of 1mg/kg once every 24 hours.  

The head tilt could be a Red Herring here.  But do consider the possibility of E. cuniculi, a protozoan parasite that can not only cause torticollis (head tilt), but also can affect the kidneys.  It can be treated with fenbendazole (Panacur) and/or ponazuril.  The combination of the two drugs together can be *very* effective.

I hope your bunny will be fine soon.

Dana

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Dana Krempels, Ph.D.

Expertise

I've lived with companion rabbits for more than 35 years, and consider them members of my family. I can answer any questions about the biology and health of rabbits, from the commonplace to the unusual. But please note:

RULE #1:
THE INTERNET IS NOT THE PLACE TO SEEK HELP IN AN EMERGENCY.

...it is an EMERGENCY.

Find a rabbit vet at www.rabbit.org/vet for immediate help, and don't risk your bunny's life by spending time asking questions online! If you can't get in touch with your vet, read these Emergency Sick Bunny Instructions.

If you have found a wild baby rabbit, please read these EMERGENCY INSTRUCTIONS FOR WILD BABY RABBITS and then use this link to FIND A LOCAL WILDLIFE REHABILITATOR who can give you the right advice.


RULE #2:
Help me help you! Please make your subject line informative if you have an urgent question. then LET ME KNOW IN THE SUBJECT LINE so I can give your question highest priority over non-urgent questions. If you don't do this, then I can't guarantee timely assistance!

For all the best, most accurate rabbit health, care and behavior information, visit The House Rabbit Society.

Experience

I have been rescuing and rehabilitating domestic and wild rabbits for about 30 years. I have written articles for many rabbit rescue publications, as well as for the veterinary journal, Exotic DVM. I own EtherBun, the internet's largest listserve dedicated to health, care, and behavior of domestic rabbits.

Organizations
Houserabbit Adoption, Rescue, and Education, Inc. (H.A.R.E., Inc.) president National House Rabbit Society (Board member)

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Exotic DVM
Warren Peace (Journal of the House Rabbit Society of Miami)
Various newsletters of the House Rabbit Society, nationwide

Education/Credentials
Ph.D - Biology
B.S. - Biology
B.A. - English

Awards and Honors
Lightspan Academic Excellence Award for web site on rabbit health and biology
(http://www.bio.miami.edu/hare)

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