CARING FOR THE CRITICALLY ILL    printable version
by
Robin Rysavy
Chapter Manager
House Rabbit Society, Kansas City, MO
House Rabbit Society Veterinarian Conference
March 7-9, 1997

Paresis/Paralysis

· Make sure the room is warm enough; sometimes paralyzed bunnies will have low blood pressure and may become cool.
· Watch for urine burn--may have to express bladder and bathe bunny's bottom.
· Bag Balm or A & D ointment is good for urine burn after chlorhexidene shampoo is used to clean the bunny and he/she is thoroughly dried
· You may have to use diapers for incontinence.
· Keep all food within reach and in a dish that is shallow.
· Keep all water within reach and also in a shallow dish to prevent bunny from falling into bowl and possibly drowning.
· Make certain the setting is comfortable--if the room is carpeted, cotton towels spread on the floor are better than synthetic carpet which may cause burns if the bunny is able to drag him/herself around.
· Move the bunny around so his/her view changes if he/she is totally paralyzed.
· Keep a paralyzed bunny in a room where there is plenty of interaction with people, but also where he/she can rest, and if this bunny has a mate (preferable) keep both together.

Head Tilt

· It's best to keep head tilt bunnies in a padded area so they won't hurt themselves when they fall and roll. The combination of bedding I use for these bunnies is: cover carpet with a plastic tarp to prevent urine from soaking through get some "egg crate" Styrofoam and fold it in half (I use the twin bed size) on top of the Styrofoam, place a large piece of fleece material on top of the fleece, spread cotton towels out to absorb urine. These will need to be changed at least twice a day.
Surround the bed with pillows.
· Sleep with your bunny if at all possible. I fix a bed on the floor in which the bunny can come and 'visit' me if she wants. It is comforting for the bunny to know someone is there and cares. When they are rolling due to loss of equilibrium, they often become terrified.
· Water may need to be syringe fed, or if the bunny isn't drinking, subcutaneous fluids may need to be administered by your vet.
· Later, when the bunny is better, you may need to rig up a water bottle close to the ground so he/she can drink. It's best to place bottles in several locations around the edge of the bed so the bunny will know exactly where everything is. Keep this
as consistent as possible. I treat head tilt bunnies as if they are blind, and a blind person needs their environment to stay the same as much as is possible.
· Keep all food within reach. Sometimes I put pellets in a bowl, and sometimes I scatter them on a towel so the bunny can reach them easier. I keep a constant supply of fresh vegetables and hay to encourage him/her to eat.
· Some head tilt bunnies cannot tolerate being picked up or held because the movement throws their equilibrium off even more. For these cases, it's best to administer medicines with the bunny lying on his/her bed, if possible. If you need to pick the bunny up, stay close to the ground and be very careful because they will have a tendency to roll and sometimes thrash.
· Some head tilt bunnies are not affected by being picked up; for these cases, I try to hold them as much as possible. Pepe, one head tilt bunny I nursed for 10 months did much better when he was carried around for long periods of time. He ate better and his attitude was greatly improved when he was held or petted. When I had to leave for work, he became easily depressed.
· For any critically ill bunny, petting is extremely important. Let them know you care.
· Watch for the slightest change-heart rate; respiration rate; change in dietary preference; presence of gas in the gastrointestinal system; a change in cecals and fecals; urinary changes. All of these may indicate a potential problem that needs to be dealt with immediately by your veterinarian.
· Watch for signs of pain; often critically ill bunnies will have abdominal pain from gas because they are eating less and the gastrointestinal system tends to be somewhat slower than normal.
· Cleanliness is important; help the bunny stay clean around the mouth and anal area; keep them brushed so they feel better. A sponge bath may help for some areas.
· Watch for proper hydration. It is great if you as the caretaker can learn to give Lactated Ringers Solution subcutaneously at home so the bunny will not be stressed from traveling. Your veterinarian can show you the amount of fluid to give and how to administer it.
· Often with head tilt bunnies, the "down" eye will become too dry and artificial tear ointment will be needed.
· Some head tilt bunnies will at some point during their illness stop eating. Syringe feeding may be necessary. Canned plain pumpkin is good and also a pellet mush, when mixed in a blender is easy to feed the bunny. Dr. Susan Brown also has some people feed their ill bunnies small amounts of a liquid nutrition called Deliver 2.0.
· Many chronically ill bunnies will have both good and bad days. Don't give up too soon. It has been my experience that a chronically ill bunny can recover even if they remain ill for months. Helping them have a good outlook is paramount to their recovery. Talk to them; pet them; love them; and most of all, expect them to get better. Remember, they will pick up on your thoughts and feelings. Try to remain as positive as you can

By: Jennifer Habernal

*Please note that no medication names or dosages are given in this information, you and your veterinarian will need to decide together what medications and/or treatments your head tilt rabbit should be on*

The pictures below show a step by step process for a safe environment for your head tilt rabbit.

The perimeter is a 2' high gold dog pen. Three panels are used here, the forth side of the pen are two 14" square grid panels, '. this makes it easier for Snowpea's caretaker to reach in. The total dimension of the pen is 2' x 2. The floor of the pen has a piece of a carpet remnant, then a 100%cotton rug is placed on top on the carpet. The perimeter of the pen is lines with a bumper pad (you can find these inexpensively at garage sales or children's consignment shops)

A blanket was folded and placed on top of the cotton rug for additional padding.

The Petsmart puppy pad is placed on top of the blanket.

A clean cotton towel is placed on top of the puppy pad. Please note that the cotton towels should be changed once it has gotten soiled 2-3 times per day.

Snowpea back in her pen. Note that Snowpea's food is always in close reach for her. There is also enough room for her to stretch out.

It never hurts to have a babysitter nearby to watch over Snowpea.

As Snowpea improved, it was clear that she needed more than a 2' x 2' pen, so using 14" grid panels, her pen has been extended to 2'wide x 3' long.

The nice thing about the grid panels (which can be purchased at places such as Target, Sam's Club, Costco) is that it can be made longer or smaller. The grides are attached to the gold pen by plastic cable ties, which can be purchased at your local hardware store.

Note the happy feet!

Dr. Pam Truman gives Snowpea her first acupuncture treatment 3 weeks after she went into headtilt.

Snowpea just after the acupuncture needles were put into place.

Not one minute after the previous picture was taken, that Snowpea did a big flop on her side and slept thru the rest of the session. This was the first time Snowpea had flopped on her side since her head tilt.

After the first month of playtime. Notice how much improved her tilt has become.

While at rest her head it more tilted, but when she is out playing it it much less noticeable.

Snowpea now has run of "her" living room and does not have to be supervised.

Understandibly, Snowpea was very unsure about not only herself, but of this new environment for the first few days. She would take a step, wobble, then right herself. This process lasted approximately ten days.

Now Snowpea runs the living room everynight and is up to five hours of playtime. She has her favorite places to rest, and loves to run under the coffee table and end tables. she also enjoys tearing and nibbling on paper!

After the first week of playtime

By Kim Clevenger, July 2003

Tiffy came into our home after being in 3 other homes the first year of her life. She was a very social bunny and a favorite with all who met her. She had an attitude and a strong personality which would benefit her greatly during the challenging last months of her life enabling her to get through her back leg paralysis with courage and spirit. This information on how to care for a bunny that has lost back leg usage is dedicated to my husband Terry who amazed me with his nurturing and sacrificial care of our beloved bunny Tiffy. He was rewarded with devotion and many, many kisses from Tiffy as well as appreciation and admiration from me.

General thoughts:

(1) Herbs are extremely helpful in any medical situation and I found them to extend Tiffy's life and quality of life by 2 years after her symptoms of unbalance first appeared. Acupuncture and chiropractic care can also greatly improve a bunny's condition and quality of life. It is important to be in contact with a professional veterinarian who is knowledgeable in these areas if you plan to participate in them. In the Kansas City area at this time, the House Rabbit Society recommends Dr. Pam Truman at Metcalf South Animal Hospital for acupuncture and herb care.

(2) Do not change medications or herbs unless the bunny's situation worsens. If your current regimen is working well and the bunny is stable, don't change.

(3) Do not underestimate the emotional part of care - a bunny receiving daily attention and nurturing will be in better physical condition than one that does not.

(4) Realize that you and other family members will need to modify your lifestyle to provide extra physical and emotional care. During her paralysis time, Tiffy was checked on at least 5 times per day. My husband or I or a friend or neighbor would come during the day to check on her, exercise her, put out a fresh diaper and give her fresh veggies/hay/feed.

(5) Realize that a bunny's deteriorating condition will affect his or her animal companions as well as the human family members. You may see behavior in them that you did not expect, even aggression, and it may be necessary to separate them for a period of time. If so, keep them in areas where they can still see each other.

Creating an environment for a bunny without back leg usage:
(1) Creating a bedding area
(2) Creating an eating stand
(3) Creating exercise time

Creating a bedding area:

In creating areas for Tiffy that I called nests I used materials that were soft, absorbent and flexible. These materials included foam rubber (which can be obtained at a fabric store in different heights and then cut to any size you desire), rubber backed 100% cotton rugs, flannel sheets/shirts, towels and materials used for babies (baby blankets, etc.). I also used disposable diapers to avoid her being wet. I used the size of diaper that matched her weight - newborn size because Tiffy weighed 3 pounds. I found the Huggies brand or type to not work well because I wanted them to lay flat. These materials could be arranged so Tiffy was sitting up or laying down.

For the sitting up nest which I used during the day, first place a thin piece of foam rubber (1-2 inches high) large enough to make a bedding area - for Tiffy this was 1 by 2 feet. Then place an all cotton rubber backed rug. Then place a diaper folded out flat where bunny's bottom will be. Then place a higher piece of foam rubber (several inches high and the length of the bedding area) on the edge of the rug to serve as a support. Then place a flannel sheet/shirt, towel or baby material bunched up and arranged in a U shape against the piece of foam rubber support. Then place veggies/feed/hay elevated to a position where bunny can reach them - for Tiffy I used a Tupperware container turned upside down with a plate on top of it.

Place bunny so that the front portion of the U shape serves to support the front half of the body and elevates it to the height where bunny can reach the veggies as desired. Place the front feet on top of/over the edge of the U shape. Then form the other part of the U shape around the body on the side and around the back area supporting both against the piece of foam rubber support.

This will enable bunny to eat or rest as he or she desires.

For the laying down nest which I used overnight, still place a thin piece of foam rubber, an all cotton rubber backed rug, and a diaper folded out flat. Then take multiple flannel sheets/shirts/towels/ baby material pieces and wrap around to make a back support not as tall or firm as the higher piece of foam rubber. Also wrap it around the side and make a gradual slope in front and place veggies and hay where bunny can reach them. It is good to cover bunny with the material to keep him or her warm overnight.

I found it helpful to spread the sheet/shirt/towel/baby material in a larger area around Tiffy so that her companions Puff and Maggie could lay with her to share her veggies and enjoy the softness of her bedding.

Creating an eating stand:

To enable Tiffy to be in different positions during the day and also to eat sitting up when she first received her veggies, I created what I call an eating stand. I made it out of common houseshoes purchased at Wal-Mart and duct tape. I used 5 houseshoes total (that was the right height for Tiffy) laying them on top of each other and inserting the heel part of one into the toe part of the next one then securing with duct tape wrapped around the whole thing. I put small pieces of foam rubber in the toe portion of the top pair to create side supports.

For the veggie holder I used Glad food containers - 1 turned upside down and a 2nd duct taped to it right side up with a portion cut out of one side for eating. I found the Glad food containers easier to cut than regular Rubbermaid or Tupperware plastic. I tried various sizes until I found the right height for Tiffy.

After the eating stand and veggie holder are ready, place veggies in the holder with the side cut out toward the eating stand. Then place bunny with front feet in front and back feet in back of the eating stand allowing it to support the body. Do not leave bunny in the stand more than 10-15 minutes. At times Tiffy would get restless and work her way out ending up on her side on the floor with no support. For eating time, this is a wonderful way to give bunny an upright position that closely resembles the normal eating posiiton. You may need to supplement side support with a towel bunched up on one or both sides.

Creating exercise time:

It was important to get Tiffy up on a regular basis and exercise her. In the beginning of her losing use of her back legs we were able to utilize a cart which is equivalent to a wheelchair for a person. We used one that a talented friend made for us using Tiffy's measurements and also one loaned to us from someone that had ordered it from Doggon' Wheels (web site www.doggon.com) custom made for their bunny. After a period of time the carts did not work as Tiffy's front leg usage came and went. At that point we would hold her stomach and allow her to move around as she desired. Exercise time for a back leg paralysis bunny is better done in short periods of time (10-15 minutes) several times a day instead of 1 or 2 lengthy sessions per day. Be sure to stop and allow them to rest when they want to do so. Tiffy was exercised at least 5 times per day. Usually exercise time involved eating at some point. We would support her for this by holding her up by her stomach.

Final thoughts:

Caring for a paralyzed bunny requires dedication and work. It involves time and energy and money. Most importantly it involves love - both from human to bunny and bunny to human. I was ready to euthanize Tiffy before my husband Terry was. He chose to extend her life and care for her in her paralysis. She knew the sacrifice we were making to create a quality life for her. After her paralysis, she began kissing us and became more affectionate than she had been. She left us when she was ready. She stopped eating one day and died the next day in Terry's arms. I hope this information will be helpful to you if your journey of love with a bunny takes you down this road. I know for our family it was well worth it.

Tribute to Tiffy

August 24, 2003
Terry Clevenger

Rabbits have always been my wife's thing, and although I help with their maintenance, and certainly feel bad when we lose one, I've never considered myself an integral part of their care.

However, they say there's an exception to everything, and Tiffy turned out to be that one exception.

My wife had warned me for over a year that, with Tiffy's ecuniculi, we should be prepared to see her go downhill rather quickly. I managed to evade reality until after Kim got back from a trip to see her folks this past January. There had been no signs whatsoever that Tiffy was ailing, but shortly after Kim's return, she lost the use of her back legs. The sight of her trying to maneuver around with just her front legs was both alarming for us, but also encouraging, as Tiffy seemed to be unaware of her handicap, and gallantly tried to live a normal life.

However, I once again had to face reality when Kim told me that, with me going back to school after Christmas break, and with her at work all day, there would no longer be anyone around to provide the increased care Tiffy was requiring, and the humane thing would be to put her down.

Well, the day came to take her to the vet for the procedure. I sat on the bed with Tiff and Kim, and confessed my great reluctance to go through with it. My argument to Kim was I still saw a lot of spirit and life left in our little white mass of fur, and it just didn't seem the right thing to do, at that point, anyway. Kim emphasized that without someone available during the day to dry her off from wetting herself, and getting her fresh food and exercising her legs, it just wasn't good to let her go all day. I (fairly immediately, acting mainly out of emotion and not logic) piped up that I would come home from school every day and take care of her.

School consisted of an internship at a nearby community college, and my schedule there was such that I could plan a slightly long lunch period to dash home, get Tiffy re-situated and fed, and run back. This I did for the next three or four months. It was terrible, grueling, sacrificial work (?), especially when I had to see that little head pop up from her nesting area when I came in her room, and start moving around rather excitedly, knowing some extreme TLC was at hand. I also really hated having to pick her up and snuggle with her (??), petting her and, later, having to endure the misery of her "bunny kisses"; she knew what we were doing for her, and she generously let her appreciation be known!

Over those months Kim and I devised all sorts of little inventions to help Tiffy's condition. One contraption---and that's indeed what they were---were variations on the idea of a chariot-like device that she could get into and, with the use of her front paws, maneuver herself around our den, with a rear wheel assembly taking the place of her useless legs. Although rather humorous for us, it never really worked that well for her, and we eventually abandoned this little experiment (however, we owe great gratitude to "Bob" for his tireless engineering and tinkering with this idea!).

Kim also became quite talented at figuring out ways to prop Tiffy up against small blankets and pillowcases, so she had support against her back to be able to eat and drink, plus enjoy her surroundings. Although her different configurations cannot be detailed here (see separate story), it was important to give her the ability to have access to food.

Caring for Tiffy during this time was never a chore or burden. Her spirit and spunk was such that Kim and I seemed to dote heavily on her, something the other rabbits did not fail to notice! We seemed to compete for who would hold her in the evening while we watched TV, and, since somebody had to clean up the bunny rooms (Kim), I usually won that honor.

Besides her tremendous spirit, something else that was very evident about Tiff was her incredible appetite. Anytime we brought her food, she would devour it with the zeal of someone lost in the desert for a week! We could never figure out where she was putting it, as she remained rather thin. However, Kim revealed that it was the disease that was eating up the calories, only giving the illusion of our heroic bunny holding off its terminal effects.

I remember spending a very fun Sunday afternoon parked in front of the television, with Tiffy parked contentedly in my lap, waking every several minutes, just long enough to nibble on some veggies or wrap a front paw around my thumb and lick my hand at some length. The phrase "wrapped around her finger (paw)" was never better illustrated!

A few days later I had to go out of town for an overnight trip. When I got back in the evening, Kim reported that Tiffy had not eaten for 24 hours or so, and she was quite worried about her. Indeed, when I knelt down on the floor to pet her and love on her, she did not respond as usual. Nor would she give in to my attempts to feed her.

Kim spent a restless night with Tiffy, trying to get her to eat something, anything, and watching to see that her bathroom habits were continuing. The next morning she brought Tiff in to our bed, waking me with the announcement we needed to get her in to the vet. Our ailing bunny lay next to me while Kim tended to the other rabbits, and then headed to take a shower, after which we would take her in. Tiff seemed to need to hold her head up, almost like she needed air. I got up and was holding her upright to help her breathe better, but something told me she wasn't right. I urged Kim to get dressed, as we didn't have time for her shower---we needed to leave NOW! I dashed out to the car, and just as I opened up the driver's door I could feel Tiffy go limp. Kim came up and took her so I could drive. I backed out of the driveway, and as I shoved the car in first and took off down the street, looked over at her in Kimmie's arms; "She's gone," I told my wife. Kim tried to keep Tiff alive by talking to her, but she just slumped in Kim's arms. We decided to make the trip anyway, just in case there was still a heartbeat. We were in the vet's office a few minutes later, and he put a stethoscope on Tiffy's chest. A few minutes later he took the tips out of his ears and shook his head at us, then kindly left us alone for our goodbyes.

Kim and I are glad she went the way she did---on her terms, Kim likes to say---quick and painless. We did not relish the prospect of taking her in, seemingly healthy and alert, and putting her to sleep. I'm also extremely glad I was so adamant about not having her euthanized early on. "What if" would always have been a haunting thought for me. I've never had such an experience with one of our bunnies. I hope, in some ways, I never have another. But this was a very, very special few months with "just an animal".

Tiffy was six years old or so when she died. I know in rabbit years that's "retirement age", but it just seems so short. Tiffy never was very big or fat; she always had the look of a young bunny. I think that's what made her, even in advanced years and with her illness, always look so cute. She was just a big fluff of fur; you could hardly tell if you were looking at her head or rear. And then after her legs gave out, she really laid it on thick with the bunny kisses as we gave her all the special care we could. Her incredible spunk her last few months was the icing on the cake for all the reasons we came to love her so much.