Philip update

He seems ok (well, same as he was before he left)

Not had the discharge report through yet but the vet emailed last night to say we'd get it today along with a list of the new drugs and doses, she's also going to call later on to discuss his care some more.

So his daily drugs are now:

Loxicom 0.3ml twice a day
Paracetamol 0.35ml twice a day
Prochlorperazine 0.27ml twice a day
Emeprid 0.46ml twice a day
Gabapentin 0.07ml twice a day
Tramadol 0.23ml twice a day

He was also getting marbocyl in his ears once a day and baytril twice a day, so need to ask if we've to continue with that. Also think we'll be treating for EC again so add panacur to the list.

If anyone is interested here is the full report from the D!ck vet:

Diagnosis: Multiple issues including:
- Partial dislocation at the base of the neck
- Wax within both external ear canals
- Small liver cyst
- Small lung nodule
- Small areas of mineralisation to both kidneys
- Mild acquired dental changes
- Lumbar spine arthritis

Medications to Continue at Home:
Prochlorperazine syrup - Please give 0.27ml two times daily by mouth (if his wobbly episodes worsen, this can be increased to three times per day).
Emeprid oral solution - Please give 0.46ml TWICE daily by mouth.
Gabapentin 50mg/ml solution - Please give 0.07ml TWICE daily by mouth.
Tramadol oral solution 20mg/ml- Please give 0.23ml TWICE daily by mouth.
Please continue with Loxicom (aka metacam/meloxicom) and Paracetamol as previously administered.

We would recommend using an ear cleaner twice weekly (e.g. Cleanaural Dog Sensitive or Otoclean) on Philip's ears and they can be cleaned again at his revisit appointment. Continue using the ear cleaner provided by your own vet. It is enough to gently dribble 0.3ml of cleaner into each ear and carefully massage both ear bases for Philip. Any extra liquid can be gently wiped away. Avoid using cotton buds as this can end up poking wax deeper into the ear canal.

Re-visit Instructions: Please e-mail us with an update on Philip's progress towards the end of this week. We would recommend a check up, either with ourselves or your own vets in 10-14 days and we would repeat an ear clean, weight check and clinical assessment at this point. A repeat blood sample could also be taken if required.
Dietary Recommendation: As Philip is underweight, we would recommend actively providing supplementary feeding to him in the form of an Oxbow syringe feed twice daily, as well as his normal hay, complete pellets and leafy greens. We would recommend feeding 10ml of Oxbow critical care TWICE daily, even if he is eating on his own. He gained 15 grams of weight overnight with us, so over the period of even a week with daily feeding, he could start to regain more strength leading to muscle mass redevelopment.

To assist Philip with ready access to his food and water, they should be offered at a low level e.g. scatter fed on the floor, or low sided bowls and low positioning of his water bottle and low lipped bowl of water. This will make eating easier with his neck troubles.

Clinical Investigation:
Blood test: Although Philip was very well behaved and sat very still for us, his small size and small veins meant we were only able to get enough blood volume to run a general health profile and not an additional volume to send away to our external laboratory for an E.cuniculi test. If you would like a repeat E.cuniculi test, we would recommend Philip coming back to us in a week to have a repeat blood sample, or being seen at your own vets for this blood sample to be taken.

The results of his general profile found that, although his total white blood cell count was normal, there was an alteration to the ratio of two of the individual types of white blood cells. One was a little low, which can be seen in rabbits when they are a little 'run down' and the other a little elevated which can be consistent with chronic inflammation. It is therefore advisable to try and build up Philip's body condition with some supplementary Oxbow feeding and it is a good thing that he is already on anti-inflammatory medication.
Very importantly from our blood test, we found his kidney parameters were within normal reference range. This is always a relief in an older rabbit who is in a thin body condition.
One further abnormality was a very slight elevation in his Bile Acid levels, which is an indication of liver health. This could be related to the small cyst-like structure that we saw on Philip's liver. At this stage, no action is required, but we may want to monitor the Bile Acid levels in the future.

Computed Tomography Scan: Philip underwent a conscious computed tomography scan. As the scan was performed conscious, Philip was in a slightly hunched position, which can make interpretation of the images more challenging. He did hold very still for us and thankfully we were able to obtain diagnostic quality images. We did not give him intravenous contrast agent as, due to his reduced body condition, there is an increased risk he could have had an adverse reaction to this.

The main findings from the CT scan were:
- No signs of middle or inner ear disease
- No visible lesions or masses within the brain (post-contrast views would have helped us to visualise this better)
- No destruction of the bone to the middle ear
These findings are therefore positive for Philip as we can assume his mobility issues are due to either E.cuniculi or his neck issues, or a combination of the two.
Other CT findings include:
- A significant finding that could explain Philip's mobility issues is a moderate to marked dislocation of the neck (atlanto-axial misalignment). Due to the position of the spine at the base of the neck, Philip has narrowing of his vertebral canal which is putting pressure on his spinal cord. This explains his hunched shoulders and reduced mobility. When handling Philip it is important to be gentle and also careful when medicating him. It is difficult to know what has caused this, although age related deterioration of bone integrity is one possibility, as is accidental trauma (e.g. Philip getting a fright and jumping into a wall). Due to Philip's small size, unfortunately there is no surgical treatment for this, therefore we will need to medically manage any clinical signs associated with pain relief and be mindful to be extra careful and gentle when handling Philip.
- Multiple little areas of mineralisation (stones) within both kidneys. When compared to Philip's previous scan, these are unchanged, therefore we would consider these an interesting but not significant finding. No action is currently needed for these.
- Another finding is the small cyst-like structure to one lobe of his liver. At this stage, it is possible this is an age related change and does not seem to be clinically significant to Philip's current presenting signs. If we wanted to be proactive, monitoring of Philip's Bile Acid levels with a repeat blood sample in 1-2 months would be recommended.
- There is small nodule/lump to one of Philip's lungs. This has the appearance of a granuloma and, again, is considered a non-significant, age-related, finding.
- There are some mild age related changes to a number of tooth roots. No action is required for these.
- The arthritis previously noted to the lumbar spine is unchanged from Philip's previous scan results.

Plan: The plan for Philip should be based around palliative care. The aims being:
- Keep him comfortable with his pain relief cocktail - Gabapentin, Tramadol, Loxicom and Paracetamol
- Improve his weight and body condition with supplementary feeding
- Maintain good hygiene for Philip and we clipped his claws and clipped fur from around his bottom while he was in with us to help with his ongoing care.
- Treat any additional mobility issues. If Philip starts worsening with an increased frequency of circling, new signs of head tilt, involuntary eye movements or more falling over episodes, then it would be worthwhile to restart another 28 day treatment course for E.cuniculi with treatment of Panacur (fenbendazole).
Further Information: Philip is a lovely little boy and we are sorry he has a number of different problems. He is a little bit complicated with his various issues, but I think we have a good plan moving forward. If you wish to discuss Philip's case or have any concerns regarding Philip sooner than his recheck appointment and update, please do not hesitate to contact the team.

Blimey, that's a lot to take in. A lot of meds too. Dear boy.... is he keeping in good spirits, that's the main thing. I know he will get all the love he needs to help.
Thinking of him. And you,.

Philip seems a bit more lively now he's on all the painkillers, the circling is not improving at all though. Hopefully the panacur takes care of that. Unfortunately as he's feeling a bit more likely he's wanting to come out of his space but its not really a good idea as when he starts to fall over he picks up speed and either falls or crashes into things which we obviously really need to be avoiding.

He's got a check up appointment at the D!ck vet on 3rd May. My own vet has suggested physio/physical therapy, with his neck I am not keen on him being manipulated at all however they also offer elecro/laser therapies so we've been referred and have an appointment at the start of June. He's likely to get sore muscles with his reduced mobility so hopefully this will help.

Have you tried a heat lamp? My vet recommended one for Reboot to help with his sore back. He recommended a simple set up as used for re[tiles. I got a bulb and holder with cable and it cost under £35. I set it up over his favourite sleep/laze spot and he loved it, it helped him relax.
Maybe something like this could help Philip.

woodwench wrote:Have you tried a heat lamp? My vet recommended one for Reboot to help with his sore back. He recommended a simple set up as used for re[tiles. I got a bulb and holder with cable and it cost under £35. I set it up over his favourite sleep/laze spot and he loved it, it helped him relax.
Maybe something like this could help Philip.

I haven't, although he does have a heat mat (which currently he's not using at all). A heat lamp might be a good idea but the way he's set up the only place it could really go is in the corner (where the plug socket is) and he doesn't go over there at all :/ I'll have a search tho and see if there are any options that might work for Philip

Philip had his physio session today, it went ok I think. We've got a hire of the pulsed magnetic therapy machine on her suggestion, hopefully it makes a difference. She agreed a heat lamp might help him feel better, I've not found cheap enough to buy (in case he has absolutely no interest at all) so maybe see if I can possibly borrow one to try.

Heres the report:

Findings:
• Very hunched through his thoracic spine
• Global loss of muscle bulk, in particular through the muscles that run either side of his spine
Treatment:
• Pulsed magnetic field therapy (PMFT) on the nerve setting to help stimulate nerve conduction
• Class 3b laster (cluster), applied along his thoracic and lumbar spine, to help to stimulate normal cell function as well as relieve pain
• I suggest trialling the PMFT unit at home as outline on the sheet provided
• Try setting up a 'proprioceptive track' in the area that Philip normally mobilises - small sections of good traction surfaces (carpet tile, towel, bubblewarp, astro turf etc.)
• Try applying heat to Philip's back for 5-10 minutes once an evening to help reduce any tension and improve circulation.

I used a very simple and cheap heat lamp for Reboot. The lamp/bulb was the same as used for Reptile tanks and fitted into a holder on a lead that you could plug in anywhere. I just hung it over his favourite napping spot. It totalled about £45. I could have bought a stand to hang the lead from but it was lucky that I could hand it from a wall sconce.
Reboot had arthritis in his spine that was interfering with his bladder nerves. He had to have his bladder expressed. He had the treatments you mention, preceded by the heat treatment. Nothing really helped him though and the clincher was the mass of fatty deposits in his abdomen that were crushing his stomach and bowels and starting to affect his major organs too. There was no hope ... an operation to remove the deposits would have given temporary relief to his stomach etc, but the mass would have formed again. Because of the bladder problem and the arthritis, for which nothing could be done, the kindest option was the heartbreaker. He was such a bright, clever and previously active rabbit. I just miss him terribly.

I've not managed to sort a heat lamp for Philip yet, and I still don't know how I'd fit it anywhere.

He was at the vet for a check up today and to have a look at his eyes as they are still a bit sore (I think this will just be a thing from now on) so to prob just get more isathal. Anyway turns out he has had a bleed in his right eye. It appears that its not currently bleeding as the blood is settled towards the bottom of his eye. So I'm now getting him a referral to another vet nearby who also have an exotic/opthalmic vet to get a better look at his eye.

Oh the poor toot! How is he otherwise?

He is much the same within himself.

Unfortunately yesterday I noticed that his eye was completely red, no longer just blood settled at the bottom of his eye. I had already spoke to the other vet practice and was getting a referral for hopefully monday as that was their first appointment, however as his eye appears to be worse my vet spoke to them and we now have an appointment at 9am today.

The condition of his eye was bad and needed removing. Unfortunately surgery was just not an option for Philip. We had to say goodbye.

I can hardly believe I read your post.... dear Philip. It was so sudden..... My thoughts are with you ....