Suddenly lethargic bunny

[SBanks16]

Hi all,

I have a 6 year old rabbit that collapsed/fainted at the vet and had weakness in his back legs (couldn’t stand up or hop), heart rate, temp and breathing were all normal. The episode passed within 20-30 minutes and he was back to moving about normally. They ran bloodwork and his kidney values have gotten worse since his last check (previously tested positive for EC, kidney disease is suspected to have been caused by EC – diagnosed a little over 3 years ago). I give him sub-q fluids for kidney support but he’s never shown symptoms of kidney failure.

He’s being treated with Fenbendazole as the bloodwork showed he had an EC flare up but since this episode, he’s severely lethargic, loss of appetite and not drinking. He doesn’t seem to be in any pain, just constantly tired/sleeping and not wanting to eat or play. I’m syringe feeding since he has a history of GI stasis, also has dental issues and he regularly has his teeth floated.

He is normally a very active rabbit and follows me around all day but this change in behaviour is pretty drastic and I have such a bad feeling he won’t recover from this. Could he be slowing down due to age (medium sized breed – 9lbs) or the progression of the kidney disease?

 

How long can a rabbit live with kidney disease?

 

 

[Bam]

I’m very sorry you’re going through this.

It seems reasonable that his symptoms are caused by the EC flare-up. The sudden but passing hind body weakness sounds like a type of seizure. Seizures typically makes both animals and humans very, very tired. Hind body weakness or paralysis is a typical finding in EC buns.

It’s not possible to say how long a rabbit can live with kidney disease, since kidney disease doesnt progress at the same rate in all individuals. During an EC flare up, the kidneys can become inflamed, but this inflammation might subside, and the kidneys gain back a lot or most of their function.

6 years is considered middle aged in a rabbit (old in giant-breed rabbits). But its really the same as with humans, some people age quicker than others and its only to an extent dependant on environmental factors. Genes play a huge role.

Your bun seems to have been struggling with several health problems in his life, and that will of course take a toll.

It’s good that you support feed. He desoerately need high quality food, such as Critical Care or other recovery formula. With support feeding and Sub-Q fluids, he doesnt actually need to drink much.

Are you giving any other meds besides Fenbendazole?

 

[SBanks16]

Thank you so much for the quick reply! His vet suspects a seizure as well, or something with the heart, he’s scheduled for an ultrasound at the end of the month, unfortunately they’re limited in the tests they can run because he’s not a good candidate for sedation.

 

He’s on Gabapentin and trimebutine for gut motility, syringe feeding with critical care mixed with some baby food,  I was worried that he wasnt drinking much but I guess he’s getting enough from the sub-q fluids and syringe feedings and he’s maintaining his weight.

His kidney disease was progressing slowly but the values shot up after this last episode, hoping it’s just the inflammation you mentioned.

 

I’m trying not to bother him and just let him rest. If this sudden lethargy is because of a seizure, do you know if rabbits typically recover from it?

[Bam]

As long as he is maintaining his weight, I think he’s fine regarding food and hydration. It is very good to weigh a poorly bun daily or every other day and keep a weight diary.

EC is an intracellular parasite that can suddenly, when conditions are favorable, start to multiply extensively. Eventually the cell harbouring the parasites will get so full it will burst and spill out its contents + the newly formed parasites into the extracellular matrix. This will elicit an immuno response from the host (the rabbit), and the response will be in the form of  inflammation. Inflammation is supposed to help the body fight “invaders”, but sometimes it goes overboard and the powerful immuno response becomes more harmful than the actual root issue. Humans and dogs will get corticosteroids to bring down the inflammation, but rabbits are extremely sensitive to corticosteroids and should only ever have them as a last resort. (In which case a single dose injection can be highly beneficial). Anyway, if the inflammation can be brought down or subsides spontaneously, the kidneys can recover, with “only” some ensuing scarring.

The gut motility drug hes getting seems quite right.

Gabapentin is mostly used for nerve pain,. How long has he been on gabapentin? I had a dog that got gabapentin for a bad back, and had to adjust down the dose quite a bit. The full dose turned her into a zombie. Some individuals will respond in this way to gabapentin, whereas others are just fine and dandy and more active than before.

Post-seizure lethargy and drowsiness is transient in both humans and animals. A seizure can be likened to a neuronal storm, with nerve cells firing like mad. The drowsiness after is normal and also considered benefical.

[SBanks16]

Almost 1 year and a bit on Gabapentin, and it’s been adjusted to a super low dose to not cause drowsiness so definitely not the medication, the lethargy only started after the episode at the vet so I will continue the feeding and fluids and him get some well needed rest. I’m not sure why they want to do the ultrasound on his chest, I don’t think he has any heart issues and the vet already suspects he had a seizure and after chatting with you, I feel that’s definitely what happened but I’ll keep you posted.

 

btw that is the BEST explanation about EC I’ve ever received from anybody, thank you so much. I feel much better.

[Bam]

Thank you 😃

Kidney disease can hurt the heart, so maybe that’s why your vets want to ultrasound the heart.

I totally agree of course, that the Gabapentin wouldn’t be the cause of lethargy if he’s been on it for a year.

28 days of fenbendazole still remains the golden standard for the treatment of EC. It  seems to have fewer serious side effects than the other bendazoles. Meloxicam is often given to help bring the inflammation down, but unfortunately, meloxicam is hard on the kidneys, so it must be given with great caution, if at all, to buns with EC of the kidneys.

I sincerly hope your bun will recover.  You are doing all you can do. Now it’s all about patience and hope.

 

[jerseygirl]

In agreement it seems like a seizure. But I can certainly see why your vet want to rule out a heart event.

What was the reason for the vet visit in the 1st place? Where you seeing some EC symptoms?

Was he put on trimbutine from that day? Has he had this before?

The new round of  fenbedazole could contribute to the lack of appetite. Unfortunately it also can cause additional inflammation initially as it starts to kill of ec and and any worms if present & susceptible to fenbedazole.

Hope your little guy comes good soon.

[SBanks16]

Hi jerseygirl,

 

He gets depocillin shots once a week for dental abscesses, it was a regular weekly appointment when he collapsed, wasn’t showing symptoms before.

He’s been on trimebutine before, he has chronic issues with GI Stasis. He’s been on fenbendazole before too and I’ve never seen such a change in him, I can’t tell if it’s from inflammation from the EC flare or that seizure, I’m just hoping he starts to show improvement by Friday, when the vet sees him next.

 

Thank you all!

[SBanks16]

I ended up having to take him to the animal emergency last night because he developed weakness on his right side and kept falling over. Thank god they had an exotic animal vet there. She said he definitely experienced a seizure but they don’t want to put him on medication yet. She wanted to do a CT scan which I declined because they said they would have to sedate him but I know he doesn’t respond well to that. She said they wanted to see if he has lesions on the brain but I don’t want to risk his life for something they can’t do anything about if they did find lesions, I hope I made the right decision.

 

They also confirmed the lack of appetite and lethargy is from the fenbendazole. The weakness is slowly improving and they put him on Meloxicam for the inflammation caused by the EC flare.

 

His regular vet moved up his ultrasound for his heart to Friday. She said we need to discuss quality of life if he doesn’t start eating on his own and showing improvement after this course of fenbendazole 🙁 he has so many health issues but he’s generally been a happy dude so the change in behaviour with him is huge.

He naps most of the day but perks up around 11pm to midnight. He runs around and plays with his toys and wakes me up for pets. I’m cautiously hopeful he might pull through.

[Bam]

I agree, it doesnt seem much point to do a CT. The brain lesions caused by EC are as a rule microscopic and treatment would be the same as now regardless.

It sounds good that you got meloxicam. We have a long standing member whose bun has EC of the kidneys since he was quite young. He gets meloxicam and fenbendazole when he has flare-ups. Keep in mind that meloxicam can make a bun drowsy at the start of treatment. This side effect as a rule subsides within a week.

Seizures are common with ec.

28 days on fenbendazole 20 mg/kilo bodyweight and day is standsrd treatment. Many vets choose to extend treatment to 5-6 weeks if symptoms persist after the first 28 days. Fenbendazole is a slow-acting drug.

 

[SBanks16]

Thank you so much! I really appreciate the support and guidance on this forum. Fingers crossed that the vet doesn’t find any heart damage tomorrow.

[jerseygirl]

I’m glad there was an exotics vet attending. That was very fortunate!

You know, I’m reminded now of Maple, my rabbit that developed head-tilt. It was never truly established what the cause was (or ear infection, ec) but we treated for ec regardless. I remember the vet talking about brain lesions and about how they can heal.

We treated for possible inflammation and possible infection. The improvements really happened in following weeks after the fenbedazole had finished. Other stories I’d read at the time had a similar trajectory, will the improvements happening afterward. I truly couldnt say whether the fenbedazole helped or not. We weren’t testing for ec indicators like in the tests they have today. So it could have just been the result of time and healing regardless of fenbedazole. I’d still choose to have treated her with it though.

Although not the same as what your rabbit is dealing with I just thought it might provide some hope or insight to ask more specific questions with his regular vet.

I suppose with Maple, it came down to giving supportive care, treating with what we thought might help as long as she could tolerate  it and just allowing the body to do the rest. I do remember the anxiety around whether it was fair to keep her going but I did have the benefit of having other anecdotes that gave me an idea of how things would look and how long it could be like that. She also showed me little moments where I felt like she was ok… She’d adjusted to her temporary upside down world and started displaying normal behaviours & appetite, although she did tire quickly.

I hope you have positive news after his heart check. Got everything crossed for you guys.

[SBanks16]

@jerseygirl thank you! He’s not as lethargic as he was, he’s starting to play again but he gets super tired quickly and has to lay down after a short run. Your Maple almost sounds like she had EC as well.

His heart was fine but unfortunately the vet found that one of kidneys was starting to look smaller than the other, they were both normal on his ultrasound last year. They’re both damaged, just one worse than the other.

thank God for that ultrasound, they found a cecal impaction so he’s now getting a dose of trimebutine every 8hrs and sub-q fluids are being increased and he’s scheduled for another ultrasound in 2 weeks to make sure he’s passed it. His litter box and farts smells horrendous but it’s slowly coming out.

She said the seizure was definitely due to EC and agreed there was no use in doing a CT to check for brain lesions since the course of treatment would be the same anyway. She said he’s developed a slight head tilt but hopefully not permanent. It’s so small I didn’t even notice it myself. His symptoms seem to be approving and his appetite is getting better, he’s eating a bit on his own but I’m still feeding critical care because he’s not eating enough.

Thank you all so much! I can’t believe this was all due to EC, this is by far the worst flare up he’s ever had but I think he’s gonna be fine.

 

[SBanks16]

Quality of life question:

 

Hi guys, you’ve been extremely helpful in your responses above so I’m hoping to get your advice here.

 

He seemed like he was starting to recover from the EC flare up but his hind legs have given out again, he’s slowly regaining function and we’ve started round 2 of Panacur but the scariest part is a huge mass he’s developed in his abdomen, the vet wasn’t sure what it was and thought it might be cancer. I mentioned last month that he had a cecal impaction that was being treated with trimebutine but after the most recent X-rays and ultrasounds, the vet found that the mass is actually his cecum that has taken over the entire abdominal cavity and is displacing his organs.

 

Obviously the trimebutine is not working. She gave him an injection of reglan massaged/squeezed his abdomen to try and get him to pass gas/poop/Cecotropes but nothing came out. She said to take him home and he should start passing poop and cecatropes within 8hrs but nothing. I’ve been continuing reglan (tiny tablets) at home but there is no improvement.

 

He has no appetite but will eat a little bit sometimes. The vet said the pressure on his stomach is possibly making him not want to eat. I’ve been giving critical care and sub-q fluids for 2 months and tummy massages everyday and not only is there no improvement, he’s getting worse. At this point, he has dental disease (abscesses in jaw), kidney failure (X-ray showed possible cancer as well), month 2 of an EC flare, and now this extreme cecal impaction (he looks pregnant and waaaay overdue). He’s peeing constantly because the cecum is pushing on his bladder.

 

He doesn’t seem to be in pain (I know rabbits hide pain but he’s not good at that) but he’s on a high dose of Meloxicam and Gabapentin so that could be masking the pain. He has moments when he seems to be his normal self and will take a treat but I feel like I’m literally keeping him alive with syringe feedings and pain medication.

 

The vet has said there is nothing left to try if the reglan does not start working to empty his cecum, and it’s not. He will not survive surgery.

I don’t want to euthanize too soon because he seems okay sometimes but I don’t want to wait until it’s too late and have him suffer a painful death (if the mass starts to displace his lungs and he can’t breathe).

What would you do?

[DanaNM]

I think this is mostly repeating info from your other thread, but in case this didn’t get shared I also found this video really helpful:

Another thing to do is to track good days and bad days, because it can be hard to tell the balance when you are in it.

I’m very sorry you are going through this, it’s never easy. Whatever and whenever you decide, it won’t feel like the right time because we bunny owners tend to feel guilty no matter what we do.

. . . The answers provided in this discussion are for general guideline purposes only. The information is not intended to diagnose or treat your pet. Seek the advice of your veterinarian or a qualified behaviorist.  

[Author]

Messages